One of the things I’ve learned working at Apple is that there’s always a right way and a wrong way to say something.  And after entire shifts of having to tell customers that their iPhones show liquid damage and are out of warranty, I’ve gotten pretty good at differentiating between the two.

The same is true online.  For instance, one of this year’s sources of intense controversy at Swarthmore, the blog Womyn of Color Blogging, recently shut its doors following a series of comments that the blog’s author perceived as gratuitously hurtful.  Whether or not that’s the case, and whether or not I agree with the author’s decision (I don’t; the best way to validate a troll is to throw in the towel), anything the commenter was trying to say has been lost because (s)he failed to articulate it in a constructive manner.

Particularly when sensitive issues — like out-of-warranty iPhones or body image — come up, it’s easy to take an otherwise objective conversation personally.  It’s difficult to ferret out the nuggets of truth in argument from beneath the layers of emotion.  And throughout the life of Womyn of Color Blogging, that was the case.  The author, whatever her intentions, took every opportunity to make reasonable discussions into personal attacks (the now-infamous “fuck you list,” which I think is also a Lily Allen song, comes to mind), and her readers, for their part, either chirped in with “you go girl”s or, on the opposite end, wrote insulting poetry.  Neither of these things are productive.

For the record, I agree with the gist of what the commenter was saying.  I think the concept of medical “fatphobia” is a delusion.  I think that making obesity into a social rallying cry is dangerous and unproductive.  But I also think that I haven’t done a particularly good job of separating my emotions from a discussion of the topic.  So I’m going to take this opportunity, as Womyn of Color Blogging takes what I hope will turn into a hiatus rather than a full stop, to right those wrongs and quote my sister (a nutritional epidemiologist) on the subject:

1. Obesity is a strong risk factor for type 2 diabetes. Period. That doesn’t mean that only fat people get diabetes or that every fat person will get diabetes. Complex diseases such as heart disease and diabetes are never predictable by a single factor. But it does mean that fat people are much more likely to develop diabetes. Biological explanations include hormonal and inflammatory toxicity to pancreatic beta cells and beta cell exhaustion (due to the need to excrete larger and larger amounts of insulin in order to regulate the glucose level of a larger body).

2. Diabetes is a strong risk factor for numerous medical conditions, particularly those involving both small and large arteries — e.g., eye disease, heart disease, and stroke. High glucose levels are toxic to the epithelial cells that line arteries. Even individuals with well-controlled diabetes have a lifespan that is up to a decade shorter than their non-diabetic counterparts. So at least indirectly, obesity is linked to serious health issues.

3. The literature is less one-sided on whether obesity is also directly associated with heart disease and other health conditions, after controlling for diabetes. At least in my studies, physical inactivity and nutrition appear to play a larger role. That being said, I wouldn’t rule out (or in) a direct link yet.

4. There are, of course, some studies that counter #1 and #2 above. But in epidemiology, there are almost always contradicting studies and focusing on those rather than the larger body of knowledge is like ignoring the forest for a single tree. It’s bad science, and more often, bad publicity in mainstream media. I’ve produced studies with counterintuitive results and they should be published and considered, but never used as the sole basis for counterintuitive medical advice.

5. Yes, some studies have suggested that obese individuals have better survival after a heart attack [a response to this]. That may be because thinness in a hospital setting often implies the existence of other chronic medical problems or smoking. Or, it could be a real effect due to hormonal or inflammatory differences. Regardless, read between the lines: survival after a heart attack is relatively low anyways and obesity, either directly or indirectly, increases your risk of having a first heart attack. So personally, I’d prefer the thin and no heart attack approach.

5. Weight has a large genetic determinant, and based on metabolism or psychology or what-have-you it is certainly much more difficult for some people to become or stay thin. That being said, there are many studies that indicate that obese individuals who lose weight DO also shed much of their excess risk of diabetes and other conditions along with the weight. So weight loss through (reasonable) diet and exercise is still medically sound advice, even if it’s offensive to some people.

That, incidentally, is what this discussion should have looked like from the beginning.  It’s just been so long since anyone involved has (a) researched their arguments, or (b) stopped being self-righteous for long enough to actually make a reasonable argument that, when we’re confronted with one, we don’t know what to do with ourselves.  So, in the spirit of conversation, let’s all try to suck a little bit less when it comes to articulating what we mean.  That, at the very least, is what this blog business should be about.