When you think of health justice, what comes to mind?
Some public health officials are saying decoupling weight and health is a huge start to obtaining health justice.
In obesity prevention work, we’ve learned just using the term obesity can cause obesity. It increases weight stigma which has gotten really bad over the past few years with weight discrimination increasing by 66% over the past decade.
Weight stigma increases a person’s risk of diabetes, heart disease, eating disorders, and early death! It’s a risk factor for inflammation, stress, high blood pressure, depression, anxiety, higher body image dissatisfaction, weight gain, and increased blood sugar. Rates of eating disorders are often higher in people who have experienced trauma or PTSD (post traumatic stress disorder). People use food as a coping mechanism. It is legal, accessible, affordable and socially acceptable drugs, especially the foods that cause obesity: processed foods, high oil, high salt, high in refined sugar, fried foods, etc.
This is important to pay attention to and be mindful of especially as a health practitioner working in this space. Assessing the relationship between eating and trauma is essential.
We need to be focused on the root cause of excess fat on the body, which by my assessment is primarily stress caused by not having:
- affordable healthy housing
- access to affordable healthy food
- money to at least be able to save and realize your full potential
Honestly, none of these are easy to accomplish, especially during these current economic times.
What is healthy housing?
We don’t talk about housing enough in the health and wellness space but actually having a kitchen is pretty important to being able to make healthy meals. Some raw foodies say they don’t need it. They can just sit on the floor with fruits and a knife and go at it. I honestly don’t know anyone in my family who would do that so to me it is unreasonable to expect this of people. In my family, they would feel this is not hygienic and regardless of finances, most people want to be clean. That feeling of clean actually makes us feel worthy of health and healthy food.
Healthy housing also includes plumbing with clean water so we can wash our produce with water that won’t make us sick, because what is the point of spending money on organic food if the water is not clean and full of toxins?
Also mold is a big issue in cities. Mold has many impacts on our health. There are two primary groups of mold-related symptoms. The first is an immunological response to mold, which frequently results in allergy-related symptoms including sinus problems, runny nose, itchy skin and eyes, asthma, shortness of breath, and other things. A chemical and inflammatory response to mold is the second kind of mold problem. Mycotoxins, which may cause an inflammatory reaction in the body, drive this.
Weight stigma is a social justice issue.
There is historical racism and injustices within our current food environment and large scale food apartheid. This of course impacts communities access to nutrition and the lifestyle necessary to keep excess fat off the body.
The BMI (body mass index), which the health industry and some public health officials like to use, does not consider health behaviors or body composition like bone, muscle, or fat mass. Because of this, it does not give an accurate picture of health. If you are on a weight loss journey and sign up for a health coaching call and your coach is pointing out your BMI and making a big deal about it, please share this article!
A study of over 40K people in the United States using NHANES (National Health and Nutrition Exam Survey) data from 2005 to 2012 looked at health based on BMI and found that nearly ½ of overweight people and 29% of obese people were “metabolically” healthy. This seems to be more important than BMI so we will go deeper on this in a moment.
Based on this study, public health officials are saying over 74 million American adults would be misclassified as unhealthy or healthy based on BMI alone. This also affects folks who look skinny but have a high body fat percentage with the fat located in dangerous areas that put them at risk for cardiovascular events like stroke or heart disease.
NHANES data showed that those in the overweight BMI category actually have the greatest longevity out of any BMI group.
Based on the Ancel Keys’ Minnesota Starvation Experiment, when folks feel like they are starving due to a caloric restriction, it decreases their mental ability and increases their fatigue, irritability, depression, apathy, and obsession with food (dreaming or fantasizing about food, reading and talking about food nonstop). I don’t think this is where we want to lead people when we get them all caught up in BMI.
What does metabolically healthy mean?
Metabolic health is having ideal levels of blood sugar, triglycerides, HDL cholesterol, blood pressure, and waist circumference all without using medications. Only 12% of Americans are metabolically healthy. Poor metabolic health increases risk for heart disease, diabetes, and stroke.
0.5% of Americans deemed obese are metabolically healthy which proves it is possible to be obese and metabollically healthy. That’s almost 2 million people.
Less than ⅓ of participants in a study on this with normal weight had optimal metabolic health.
How does one get metabolically healthy?
To achieve better metabolic health according to the study, you have to have proper nutrition, be physically active, and a non-smoker.
A study showed that folks who had some level of college education showed to have better metabolic health which is not causative of course but it does show a glimpse of what access looks like and what it could mean for resourced folks. It says to me if you are resourced you have a better chance at metabolic health. Some college education means you had some decent education, so you also had access to funding for school. This matters when we think about policy levers to pull to help folks live optimally and be healthier. Ultimately, that is the goal.
That same study showed that Black folks over 60 were the least metabolically healthy. We of course do not have control over our race and age but this is interesting to dig into why other racial groups were not the least. It may be tied to resources.
Also this focus on metabolic health pays more attention to where the fat is stored since it is gauging waist circumference vs body fat percentage. This has a huge impact when we look at folks with different nationalities because certain groups of people put fat on in certain areas.
The American Journal of Clinical Nutrition published a study on body fat distribution in white and Black women and found where we lose fat is different between the two racial groups with all else being equal. They also concluded waist circumference was not a suitable marker for tracking changes in visceral fat for Black women.
In the study, white women had a greater fat loss in waist circumference than Black women. Since all possible contributors to fat loss variants were taken into consideration (like hormonal changes due to menopause, etc), we need to factor in the real difference between the Black and white experience to pinpoint why one group would lose more fat around their midsection.
Being concerned about fat around the waist makes sense as all the vital organs are there and fat putting pressure on them would put them at risk.
So, in the public health space, you may be wondering what we should focus on if we are trying to help people?
We need campaigns that focus on physical activity, reducing refined sugar, and reducing saturated fats.
To me this means investment in communities so folks feel safe to use the parks and walk their neighborhoods, making organic fruits and vegetables more affordable through subsidies and accessible with programs that incentivize community grocers to carry an abundant supply of organic produce, and eliminating subsidies for meat farmers so the real cost of meat can be seen at the grocery store and allow market forces to do their work.
Food choices, the gut microbiome, weight, sleep, exercise, stress, mental health are all things we can positively influence.
With that being said, having moderate weight does not guarantee good metabolic health.
8% of people who are overweight are metabolically healthy so you can be both.
The biggest impact that can be made for most people is cutting out processed foods.
This is where I find intermittent fasting and getting over salt and sugar addiction can be really helpful for folks on an individual level.
The timing of your sleep is also important, like going to bed by 10 pm. This matters more than even how long you sleep. This helps avoid blood sugar spikes after breakfast the following morning, which is another factor in metabolic health.
Stress is a huge factor, with work stress being a biggie. Mental health conditions also put people at greater risk of metabolic syndrome, and folks dealing with them are more likely to have blood sugar control issues. This includes folks with anxiety disorder, major depressive disorder, and PTSD.
The National Center for PTSD looked at this and reported in PTSD Research Quarterly about the link between racial trauma and PTSD. They define racial trauma as the cumulative traumatizing impact of racism on a racialized person. This includes systemic racism and historical, cultural, and community trauma. There does not have to be a recent or direct threat on one’s own life to experience trauma reactions in this case. There is a psychological impact of racism and events that can result in race based stress and trauma.
Although racism has been connected to a variety of mental health issues, the association between racial discrimination and PTSD symptoms is the strongest.
How can we fight hunger and poverty?
Obesity is a cause of malnourishment among other things. We have seen a huge correlation between excess fat and poverty. This paradox is due to the low price and easy access to highly processed meals that are nutrient-void and calorie-rich. But even folks who are not financially resourced know what healthier options look like. What else could be the issue here?
Higher unemployment, poorer education levels which may impact incomes, and irregular meals due to lack of funds are a few factors contributing to the rising obesity rate. Low physical activity due to not having safe spaces to workout is another factor in obesity.
We already tell folks to eat clean and workout but how accessible are we making it? It is hard to get compliance when there is no way to comply without putting oneself at risk.
We also need to widen our scope of what poverty looks like. Have you heard of the working poor? The working poor are those whose earnings remained below the official poverty line after spending at least 27 weeks in the labor force (working or seeking employment). I would also include entrepreneurs in this group because there are many that have ventured out on their own during the pandemic with not much in savings and not necessarily paying clients. They are holding on to entrepreneurship because the thought of going back to the office and having a boss is not appealing due to toxic leadership and workspaces.
Let’s look at who is being affected by this a little deeper. Being a woman and being Black are overlapping identities, and as a result, Black women are more likely to experience double oppression and double prejudice at work. They have persisted in the face of racism and misogyny but not without chronic stress and trauma. Just so happens, this is the demographic that is leaving employment and starting businesses in large numbers.
According to a 2021 study on gendered racism in the U.S. among young adult Black women, these women deal with their experiences by “identity shifting,” which involves changing one’s behavior and words to conform to social standards and is linked to depression and anxiety. These women are citing being passed over for promotions, lack of mentorship opportunities and microaggressions. No wonder they would rather work for themselves. Who wouldn’t?
How can we erase these injustices?
The weight-inclusive approach that is being recommended by the University of Illinois Chicago School of Public Health assumes that everyone is capable of achieving health and well-being independent of weight given access to non-stigmatized health care. This approach challenges the belief that BMI reflects a particular set of health practices, health status or moral character. The goal is to eat nutritious food when hungry, cease to eat when full, and engage in pleasurable and sustainable exercise. These are all self-care practices. How can we feel good in our bodies and about ourselves? That’s what this journey is about. All of this should be more accessible for people.
We should focus on root cause of health and social determinants of health to develop a long term strategy to improve population health.
We should promote eating for pleasure, hunger, satiety, and nutrition and not weight.
We should promote mindful movement focused on what brings people joy and connection.