Rating: WARTY!
Marilynn Wann is five-four and weighs 300 pounds. She's bounced up and down between size 6 and size 18, which is quite a range. She started a magazine for overweight people, arguing moderately convincingly, that we're way too obsessed with weight in this country and that it's getting in the way of our seeing what healthy is, versus blindly thinking people who don't fit an arbitrary norm are necessarily unhealthy.
That said however, I think she's glossing over a lot. She quotes from studies, but fails to reference any with sufficient detail for us to independently verify her assertions (more on this anon), and she offers a lot of anecdote which she then treats as data. This book is old (1998), so a lot of what she's saying is out of date now, and I'm not judging on how reliable her argued position is.
I really did like the title, though - turning an insult into a comeback by simply adding an exclamation mark after the "fat" and a question mark after the "so". She spends a lot of the time arguing that women need to accept themselves as they are regardless of how fat (her preferred term) they are. That's perfectly fine, and isn't quite the same as saying that fat is healthy, but it's also not informing women that being overweight does have very real health risks associated with it. She spends a heck of a lot more time extolling her weight than ever she does honestly discussing weight-related health issues, which she tends to sweep under the carpet.
Diseases such as breast, cervical, endometrial, and ovarian cancers are real problems which the author mentions in passing, but doesn't dwell upon. She fails to mention that that people who are considered medically overweight can suffer heart disease, type 2 diabetes, obstructive sleep apnea, and osteoarthritis to name a few more. It's for these reasons that doctors advise patients to lose weight, not because they want to suck large numbers of patients into their practice so they can use the fees to pay off their country club dues.
Large-scale American and European studies (not the poorly-sampled white folks that this author derides) have found that mortality risk is lowest at a BMI of 20 in non-smokers. Again according to Wikipedia, "In the United States obesity is estimated to cause 111,909 to 365,000 deaths per year, while 7.7% of deaths in Europe are attributed to excess weight" - so it's not an American Insurance company problem, it's a weight problem, and while you can argue that these are estimates and may have inbuilt biases, as more and more studies are conducted over more and more time, it becomes less and less easy to argue that being overweight carries no risk or is merely some corporate agenda. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women, for example. This isn't a myth.
That said the author makes a very good point about an overweight person who exercises having a better health and mortality prognosis than a regular weight person who sits around all day. This would seem obvious! But her health reporting is patchy. She talks briefly about BMI, but fails to mention other measures, such as BFP (body fat percentage), or an even simpler alternative which is to compare waist circumference to height. If the first is greater than 50% of the second, there's a potential problem. In terms of converting the low energy using fat into high energy using muscle, you will have limited success. Building muscle mass will help to burn energy, but only in a small way. It's better to lose the fat than to try to "covert it"!
As I mentioned, one thing which really bothered me is that the author mentions a lot of studies but references none of them, making it very hard to check up on these facts. In this regard too, it's important to keep in mind that this book is almost two decades out of date now, so some information which may have been accurate then or which may have been given in good faith then, is irrelevant now, or has fallen by the wayside in the last twenty years. Growth charts are now used, based on large numbers of children (not on health insurance companies' flawed statistics) to spot potential health problems indicated by deviation from the range most children follow. Weight and height percentile charts were changed in 2006 - later than this book was published.
According to Wikipedia, "Between 1986 and 2000, the prevalence of severe obesity...quadrupled from one in two hundred Americans to one in fifty. Extreme obesity...in adults increased by a factor of five, from one in two thousand to one in four hundred." It's really hard to explain that away as genetics, as this author would seem to have it.
I do take her point that people popularly deemed to be overweight can be healthy - and indeed healthier than certain categories of "normal weight" people, and certainly healthier than underweight people, but her attempt to classify all ranges of weight as a generic "fat" population, as though everyone is really the same, is misguided and misleading. Any classification system which rates everyone the same is doomed to failure! The fact is, despite her disparagement of the various titles (overweight, obese, big-boned, and so on) there are people who are big-boned - that is to say naturally larger-framed than others, and despite their being 'outside the norm' they can be perfectly healthy. To classify those people as no different from someone who is medically morbidly obese is plainly wrong-headed.
I want to talk some more about the surveys and studies reported in this book because this is important. On page seventy six, we learn of a survey (conducted by Weight Watcher's magazine, so there's some weird-ass bias right there), which reported that 85% of fat women said they enjoyed sex compared with 45% of thin women. 70% of fat women said they almost always orgasm, compared with 29% of thin women. Fat women are twice as likely to be happy with their partners and three fourths of them said their partners are happy with them at the present weight.
The author's writing mixes up a lot of survey results and doesn't offer anywhere near sufficient detail to evaluate the survey. This is the particularly egregious in a "survey" comparing the sex lives of "thin" women versus "fat" women. Maybe the original text clarified things, but this author doesn't reference it, and reports nothing other than positive results. We have no sample size reported here, no controls, no definitions, and no details, so we really don't know where the weight was at for the "fat" women or for the "thin" women, just as we don't know if men were surveyed and she chose to ignore their responses, or if only women were surveyed, in which case her claims are rather biased at best and sexist at worst. 75% sounds like a large number until you find out only ten people were questioned! Were only ten surveyed, or was it one thousand? Were they simply buddies of the surveyor, an informal survey of friends and acquaintances, or a scientifically randomized sample? We don't know. Therein lies the problem.
We can't tell if these were women with body weights very similar to the author, or if they were women who most people would not rate as overweight even though they themselves may have felt they were "fat", or if it was a mix of these two with a bunch of in-betweens. Without knowing this it's hard to judge the value of the responses. That's a problem I had with this author - in classing everyone who was mildly to grossly overweight as a generic "fat" it really mixed up a bunch of different people who may well have experienced a whole range of difference sexual behaviors and responses. The same goes for the "thin" women.
Most women think they are overweight to one extent or another (or have a poor body image in general) because of the culture we force them to grow up in, where if you're female, you'd better be young, pretty, and thin or you're antique, grotesque and fat. It's not a healthy climate in which to grow up if you're a girl, and it can seriously affect the value of surveys where we're told only that the subjects are "fat" or "thin" and know nothing else about them - not how often they had sex, nor whether the sex was a one-night-stand or within a committed relationship, and so on. Suppose they compared fifty happily married overweight women with fifty anorexic women? I'm not saying they did, only that we simply don't know who was compared, and therefore this survey is quite useless, at least as reported in this book. It might well have been a well-conducted, accurately-reported survey including this and other health information. A fulfilling, reliable sex life can contribute to overall wellness, but this isn't what we got as far as we're able to judge, because of the poor reporting on this author's part, and the book suffered for it.
Another study this author reported - again one which had no references showed (in 1999 we're told, in a book published in 1998!) that of 12,000 Swedes studied, the shortest people were 20% more likely to die than the tallest ones. Yet this is contradicted by, for example, this 1989 study:
http://www.researchgate.net/publication/20542546_Adult_body_height_self_perceived_height_and_mortality_in_the_Swedish_Population
of Swedish men and women which says just the opposite, and which was obviously available to the author.
I couldn't track down the survey the author mentions, and it occurs to me she could mean the one I found and simply be remembering it wrongly and dating it wrongly. It's not that she claimed anything from this study in support of her cause (except in being sarcastic about what we zero in on when considering health issues: weight, not height). The problem is that when we cannot check on her claim or when we find one that directly contradicts it, it undermines her veracity.
We learn on page 114 that 90% of dieters regain their weight within three years, but as usual, no source is given for this. According to this New York Times article, the source for this claim is evidently a 1959 clinical study of only 100 people. In a study for the National Weight Control Registry, "Dr. Wing and Dr. Hill of the University of Colorado found that on average the respondents had maintained a 67-pound weight loss for five years. Between 12 and 14 percent had maintained a loss of more than 100 pounds." They found 2,500 people who succeeded, and found them quite easily. Diets can work. On the other hand, nearly three-quarters of Americans over twenty are overweight to one degree or another, so clearly either diets do not work for the majority, or the majority do not even try seriously to diet.
Contrary to this author's claims, Samoa does have a weight problem according to this article. There's an obesity epidemic in the Pacific. Moving away from a healthy diet (in the smart eating sense rather than the 'losing weight' sense) is what caused the problem. The survey the author used was thirty years old at the time she used it, so it was hardly the best she could have chosen.
Here's what really turned me right off this book. On page 169 is a letter from a 500 pound guy who beats up people. It's included under the heading of "By Any Means Necessary" and is so far beyond inappropriate that the one can't be seen from the other. The letter says he "can hit skinny people real hard". He says he can put a hole in a wall. The letter's author claims he has found a way to get skinny people to accept him - he puts them in the hospital: "when someone looks at me wrong, I beat them up". He says, "I have been arrested three times because of it, but that is okay because I sent those people to the hospital". It was at this point that I quit reading this book and decided to rate it negatively. This book in which the author had spent 168 pages urging people to love themselves, not only quite evidently approved of this guy whose response to funny looks and insults was to send people to hospital, but the author displayed this letter proudly, talking of recruiting him to a military wing of her movement.
I flatly refuse to recommend a book like this.
