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body image, Editorials, weight loss

What’s unhealthy about the Plus Model Magazine article on plus size bodies and why it matters

Several people sent me this link to a recent article and photo shoot in Plus Model magazine. There are striking images of a plus size model next to a traditional model, making the plus model (a reported size 12) look gargantuan and the traditional model look, well, like a stick. Obviously the desired effect.

However, on further reading I found the message, conveyed clearly in the title “Plus size bodies, what is wrong with them anyway?” to be, well, unhealthy.

I am the first to admit that most runway models are way too thin. And yes, as the article suggests, I bet many of them have a body mass index below 18.5, which is unhealthy.

The article goes on the mention that 50% of American women wear a size 14 or larger, a fact I agree is lost on most booking agents and designers as most clothing companies stop at a size 14. Anyone needing a size 16 or up has to head into plus size territory. High-end denim, which for the men reading this is sized differently, often stops at a 32 (roughly equivalent to a size 12). How do I know? On a good day I could squeeze into one of the few brands that made a size 34.

The article states that we need size diversity in models and that consumers should boycott stores that are not marketing appropriately to the plus sized consumer, because:

…there is nothing wrong with our bodies. We are bombarded with weight-loss ads every single day, multiple times a day because it’s a multi-billion dollar industry that preys on the fear of being fat. Not everyone is meant to be skinny, our bodies are beautiful and we are not talking about health here because not every skinny person is healthy.

Well, now wait just a minute. Waist size is a very important measurement of health and when a woman has a waist circumference bigger than 88 cm (which is 34.6 inches and typically a size 16 in the American market) her risk of death (from all causes, not just heart disease) increases.  For men, the cut off for waist circumference is 102 cm. While I agree that we shouldn’t be telling women they look “wrong,” we should be talking about health.

Waist circumference is a good health barometer. It reflects abdominal fat, which is the exact worst place to have fat (abdominal fat increases systemic inflammation, contributes to lipid dysregulation, and is a contributor to insulin resistance, a precursor of diabetes). Waist circumference has also been studied pretty extensively, is easy to check at home, and is reflected in clothing size so very à propos to the Plus Model article.

What about the “not every skinny person is healthy” quote. Well, you can definitely be too skinny. A body mass index of < 18.5 increases your risk of mortality, just as being overweight does. And you can also have a normal BMI (19-24.5) and technically be out of shape and at risk for cardiac disease if you carry very little muscle and mostly, well, fat (which is why BMI is not the greatest measurement tool).

Waist circumference of 28, down from a 35.

And no, I’m not some skinny bitch who doesn’t get it. I was overweight from 2003-2011 and spent the last three of those years wearing extra-large surgical scrubs because I just couldn’t bring myself to shop for plus size clothes. At my peak I had a waist circumference of 35 inches and wore a size 16. After a year of dedicated efforts, my waist is now a very healthy 28 inches and I am wearing a size 8. I am now healthier and likely to live longer.

I agree that women deserve to have representative marketing and my preference is to see models of various shapes and sizes with an emphasis on healthy. I happen to be very tall, so obviously a tall model helps me see how clothes might fit for me, but I can see how that would drive someone who is 5’2″ batty. It would be no different from me trying to gauge how something might fit looking at petite clothes. And similarly, a women who is buying a size 18 should also have an idea how that garment might fit her. However, I will say that one thing that helped sustain me in my weight loss journey was the dream of a pair
of Rock and Republic jeans. God, I thought they were the epitome of sexy. And of course, they stopped at size 32. I put a picture of them on my fridge and having that goal, as superficial as it was, helped. The irony being that Rock and Republic went bankrupt during my weight loss journey and were bought by Kohl’s. So wearing a pair of the legendary Skinny Bitch jeans is a dream I will sadly never fulfill.

To say that “everyone isn’t meant to be skinny” and “we are not talking about health” is just wrong. Skinny and healthy are two different things and while everyone isn’t meant to be skinny everyone is meant to be healthy, which means (for women, anyway) a waist circumference less than 88 cm or 35 inches, clearly not in the Plus Model Magazine demographic. And so the piece comes off as one big self-serving promotion for plus size models instead of an interesting piece on body image, why women feel “wrong” when they are overweight, why clothing designers neglect the plus size market, fitness (because you can be overweight and fit), and the difference between skinny and healthy.

I agree that plus sized women should have more clothing options and be marketed to in an appropriate manner, but to insinuate that being over weight or obese carries no health risk is incorrect.

There is nothing wrong with a plus sized body. In fact there is nothing wrong with any one of us. But the truth, uncomfortable as it may be, is that being plus sized (a size 16 and up) is associated with health risks.

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Discussion

22 thoughts on “What’s unhealthy about the Plus Model Magazine article on plus size bodies and why it matters

  1. This article was completely on point. While I’m all in favor of different body sizes I do happen to realize that weight and waist size plays an important role in health. I do believe that clothes should be properly marketed to every audience because on at least a superficial level we all know that everything isn’t for everybody. I’m about 6 feet tall,I have a size 40 waist(starting to lose some of it…again) and I know that the trend of skinny jeans just isn’t for me. What annoys me is that whenever someone publishes something like this there’s always a backlash of people who completely miss the point of what’s being said and immediately accuse the author of hating women who don’t shop in the kids department. I guess what I’m saying is that I like women with some meat on their bones but there comes a point where there’s just too much meat for it to be healthy for anyone.

    Off topic but that picture made my day better even if it is a little bit like a situation-esque photo. When I finally take the weight off I’m posting all types of shirtless photos.

    Posted by T1theinfamous | January 17, 2012, 8:04 am
  2. The 88cm/34.6 inches seems somewhat arbitrary to me, considering that a woman who is 5′ tall with those measurements would look significantly bigger and have a significantly higher proportion of fat around her waistline than a 6′ tall woman with the same measurements. Doesn’t height factor in at all?

    Posted by Annie @ PhD in Parenting | January 17, 2012, 1:09 pm
    • I just looked up some weight/measurement stats of mine. For reference, I’m 6’2″.

      When I was 16 and had a BMI of barely 20, I wore a Size 10. If I ever got into a Size 8, I would be seriously underweight. I’m not sure what my waist circumference was, but I would guess probably around 30″ to 32″.

      Just before I got pregnant with my second child, I had a BMI of 24 (so “normal” BMI) and a waist circumference of 35. This is what I looked like: http://www.phdinparenting.com/wp-content/uploads/2009/12/Europe-Part-IV-2-098.jpg. Not super skinny, but definitely not “overweight” (as you say you were when you had a waist circumference of 35″).

      All that to say that for me, 35″ waist looks and feels normal and healthy, not overweight.

      Does that mean that a normal weight for me = higher risk of death from all causes? Maybe. But if it does, it seems strange to me that my risk as a slim 6’2″ person would be the same as the risk of an obese 5’2″ person just because we both happen to have the same waist circumference.

      Posted by Annie @ PhD in Parenting | January 17, 2012, 2:40 pm
      • I am a little shorter than you, so when I had a waist circumference of 35 inches I weighed 205 lbs (I am 5’10 1/2 “). That also gave me a BMI between 28 and 29, also in the overweight range.

        The studies looking at waist circumference are pretty interesting. Apparently it is almost 100% accurate at identifying “at increased risk” versus other anthropomorphic measurements. However, I am not sure how many studies, even though they are large, include many individuals much taller than 2 SD from the mean (such as you and I). There are also other measurements to consider. Waist to hip ratio, for example. If your waist to hip ration is > 0.88 then you have an increased cardiac risk. It is essentially as accurate as doing waist measurement alone, but the cardiac “experts” are supporting waist circumference because one measurement is easier to do than 2. SO you can also check waist to hip ratio. There is also a waist to hight ratio, which is no more accurate, and possibly even less accurate, than waist circumference at predicting risk. The other issue is that many people fudge their height, so that adds in inaccuracies and many offices are not equipped with a stadiometer (the appropriate tool for measuring height, think I spelled that right). It is easy to be off by 1-2 inches on height with a bad measurement in a doctor’s office. However, for a woman or man far taller than the average checking waist to height ratio might be something to add into the mix, especially if the BMI is also in the normal range.

        Posted by Dr. Jen Gunter | January 18, 2012, 7:16 am
      • and one more thing, a waist circumference of 35 inches or more for women is one of the criteria for metabolic syndrome, so it’s very well accepted.

        Cheers

        http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.aspx

        Posted by Dr. Jen Gunter | January 18, 2012, 5:38 pm
    • The woman who is 5′ with a waist circumference of 35 inches is at far greater risk than the woman who is 5’10 1/2 inches with a waist circumference of 35 inches. See my other response regarding height.

      Posted by Dr. Jen Gunter | January 18, 2012, 7:18 am
  3. I guess I don’t see the conflict here between having positive plus-size images in the media, and trying to be healthy. I would be happy to see more health-positive articles aimed at plus-size women, but I would like to see them framed in an encouraging way.
    I’m a plus-sized woman, and I didn’t read that article and think “Great, I can stop working out six times a week! I’m running out to get some nachos right now!” Do you genuinely think that the average plus-size woman has never heard that waistline metric, or other health metrics (preferably from her own doctor), or that she will decide that none of them matter if she can find nicer clothes, or occasionally see a fashion shoot or catalog featuring a model that looks more like she does?
    I don’t see where the article suggests not to get exercise, not to eat healthy, etc. And, more importantly, I have found a lot of us plus-size gals take better care of ourselves if we’re in a place of already liking/loving ourselves. This can get increasingly difficult in a society that is becoming more and more hostile and abusive to fat people (see billboards in Georgia, etc.) because they mistakenly think that shame is somehow encouraging. Positive images of plus-size models may just help plus-size women to aim to be their best, healthiest selves.

    Posted by Carolyn | January 17, 2012, 1:34 pm
    • That is exactly right, Carolyn. If you hate yourself, you aren’t going to take care of yourself. I struggle with making myself exercise, not because I hate exercise necessarily but because if I see it as a means to weight loss, it is doomed to failure. I have fibromyalgia, so very strenuous exercise is out for me unless I want to feel like I’ve been beaten with a baseball bat. I prefer walking with poles (to keep my injured lower back in alignment) and working out in the pool to attempting to run on a treadmill.
      I also have endocrine problems (pituitary and thyroid) and am going through menopause. Exercise is very unlikely to lead to weight loss in my case. I enjoy seeing photos of plus size women working out. The plus size model in the article did not look in any way unhealthy to me. She looked very lovely and fit.
      By the way, the women on my mother’s side of the family tend to be both obese and long lived. My great grandmother, for instance, lived to 80, and what killed her was not any of the so called “obesity diseases.” It was acute myelogenous leukemia, which does not discriminate based on size.

      Posted by The Real Cie | February 21, 2012, 3:19 am
  4. Low BMI is associated with increased mortality, but *from what?* To qualify for anorexia, you’d have to be well below 18.5, and what, besides anorexia, would make a too-skinny person die?

    Posted by laura | January 17, 2012, 10:10 pm
  5. I am amazed that you are unaware of the many people out there who are both fat and healthy. Well, not really amazed, because everyone just accepts the story that fat must equal unhealthy.

    And when diets fail 95% of the time, how exactly is someone supposed to reduce their waist size anyway? http://mann.bol.ucla.edu/files/Diets_don%27t_work.pdf

    I will be surprised if you manage to maintain the weight loss in five years. Please don’t beat up on yourself when it happens. You don’t have to give up eating healthy foods and exercising just because you’ll never be able to keep that certain waist measurement.

    Posted by bigbigwhitebear | February 15, 2012, 12:16 pm
  6. First off, I appreciate very much that you are trying to make this about health instead of appearance. Bravo, and than you for taking that step.

    I think you missed the point of the article. The point was, in part, that you cannot – CANNOT – look at a fat person and know what kind of health they have. As a doctor you should know well that there are plenty of plus-sized people who simply cannot lose weight for any number of reasons. No one can look at another human being’s size and diagnose his or her health. What appears healthy may be absolutely not, as in the case of the teenager (true story) who eats nothing but Chicken McNuggets (Source: http://www.dailymail.co.uk/health/article-2092071/Stacey-Irvine-17-collapses-eating-McDonalds-chicken-nuggets-age-2.html). Her pictures show an average-sized girl smiling, laughing, moving around, and looking the rosy-cheeked picture of healthy youth – until the day she collapsed and was rushed to the hospital struggling for breath. Appearance is not a health indicator, and that’s what we are fighting against.

    Fat people are stigmatized, shamed, degraded, and looked down upon everywhere we go. No human being should ever have to endure that kind of outright hostility and disgust. The point of having body-positive messages is to express to the world that we are beautiful people just as is. Period. No “but,” no “if only,” no “except.”

    The interesting thing about this whole post is that you are conflating correlation with causality. Weight and/or waist size are not synonymous with health, and obesity is not a disease, it’s a condition.

    I have metabolic syndrome myself, and while you are absolutely correct in that the >35″ waist is a symptom, it is only ONE symptom and cannot be divorced from the other factors in assessing the disorder. The other factors include serum triglycerides of 150 mg/dl or above; HDL cholesterol 40mg/dl or lower in men and 50mg/dl or lower in women; blood pressure of 130/85 or more; and fasting blood glucose of 100 mg/dl or above. (Source: http://www.medicinenet.com/metabolic_syndrome/article.htm.) These are slightly more stringent measurements than are suggested by the World Health Organization, but the key here is that waist size is only one of a group of symptoms, not a health disorder in itself.

    What would you tell someone who has a waist size of say 45″, yet has very healthy levels in all those other areas? What if that person also exercised, ate nutritionally balanced and well-portioned meals, and had excellent sleep habits? I know a number of women who fit that criteria, yet the world cannot look at them and see healthy, productive people, and that is an absolute crying shame. All we want is to be able to teach this world that fat people are PEOPLE, and we are not here to be taunted, degraded, or otherwise shamed. We are human beings who deserve to be treated with dignity and respect. We are not people “too,” we are “people,” full stop.

    Posted by The Diva | February 15, 2012, 2:05 pm
  7. Darnit. I meant to ask for links to the studies you mentioned where waist size is associated with risk. Would you mind posting them here? I would appreciate it very much.

    Posted by The Diva | February 15, 2012, 2:06 pm
  8. Using a waist measurement alone is about as accurate as BMI, which is worse than useless because it’s *seen* as accurate. And while some studies have shown that increase in waist measurement is actually a *result* of metabolic syndrome, rather than the cause, let’s assume for a moment that it was absolutely proven that larger waist measurements are solely responsible for all the problems that they are blamed for. Knowing that 95% of efforts at weight loss are not permanent and that most of those efforts will actually result in *increased* weight (and knowing that you can’t spot-tone, or whittle your waist without actually losing weight overall), what are we supposed to be telling these women with large waist measurements? That because they have health risks, they also must spend more on clothes, have fewer clothing options, and be shamed? That isn’t going to change anything – except to add to the stress in their lives, causing many of the symptoms blamed on waist measurement or weight. Nothing–seeing bodies like theirs, social acceptance, clothing availability–should be withheld from anyone based on size, whether that size is healthy or not. The author may be one of the 5% who can keep the weight off (or maybe she just hasn’t gained it back yet), but that’s not a realistic expectation for 95% of people. Those people should certainly NOT be told that their bodies are wrong!

    Posted by Rebecca Surovik (@Snowflakelike) | February 15, 2012, 2:09 pm
  9. A little off-topic, but FYI, if you’re not bothered by the idea of buying jeans on eBay, there are lots of Rock & Republic for sale there! Congratulations on achieving your new shape.

    Posted by Lisa | February 15, 2012, 3:51 pm
    • Thank you for the tip! I just checked it out. I’m not bothered by buying pants/jeans on eBay as long as I can wash them first. Now I have to figure out of Rock and Republic fit true to size or small…

      Posted by Dr. Jen Gunter | February 16, 2012, 8:10 am
  10. Ok, let’s just ignore the whole quackery of diagnosing people by measuring their waist (I can’t even… seriously?) and focus on the weight loss thing.

    There is no verified medical evidence that proves that weight CAUSES any illness. It is sometimes correlated with some illnesses at the ends of the spectrum – that is, very, very thin people and very, very fat people who are physically affected by their size (mobility impaired, dietary affected etc). Of course, most people assume anyone that is “too fat” or “too thin” for their own arbitrary standards of “normal” fall into these categories. Correlation means that for some reason, people with one trait are often more likely to have the other, correlated trait. It does not mean that one trait CAUSED the other.

    Now that said, people like yourself get all up in the faces of fat people with “You’re gonna die fatty! You gotta lose weight!” without passing any consideration to the fact that the human body is complex and diverse, and that we really don’t know what makes people fat. Oh the media and those who have an interest in selling weight loss and diet products all want us to believe that it’s because all the fatty lard-arses are stuffing their faces with food and sitting on the sofa all day. But as we know by the Health at Every Size studies, this is simply not true.

    Add to this the fact that even the inventor of BMI denounced it as a measure of individual health, and we know without a shadow of a doubt that it is complete bunkus used by insurance companies to jack premiums higher.

    So even if there was some direct evidence that said that losing weight actually changes one’s likelihood of illness, how do you propose that people permanently lose said weight (as we know weight cycling is far more dangerous than being fat in the first place) in a safe manner that is maintainable for life?

    Posted by sleepydumpling | February 16, 2012, 5:05 pm
    • You are mistaken. There is a plethora of medical science that shows obesity is an independent risk factor for many serious health conditions, even controlling for cardiorespiratory fitness. For example, breast cancer, endometrial cancer, and total knee replacements just for starters.

      Cardiorespiratory fitness is important and someone who is overweight/obese and of could cardiac status is healthier that their counterpart of the same obesity and in poor cardiac shape. However, the healthiest person is in their ideal weight range and of good cardiorepiratory fitness.

      There are many studies using waist circumference because it is a predictor of metabolic syndrome and even without metabolic syndrome belly fat is more inflammatory and worse for a myriad of health conditions.

      Posted by Dr. Jen Gunter | February 16, 2012, 7:00 pm
      • Wait, wait… an “independent risk factor”? Is that proof of causation? I think not. Surely as a supposed doctor you do understand the difference between causation and correlation? Don’t you?

        But you’ve also failed to address the issues of BMI being bunkus, there actually being a proven method to lose weight permanently (there is not) and the fact that human beings are not made out of a mold that has everyone’s base body measurements being exactly the same.

        All this scare-mongering that people have to be thin or they’re gonna die… what purpose does it serve? It doesn’t make people thin, it doesn’t change people’s body shape, it doesn’t make people healthy, it doesn’t make anyone live longer and it doesn’t have any proof to back it up.

        I think perhaps it just makes some people feel superior to others based on their size, and feel they have the right to gloat over supposed health. Evidenced by your need to “show off” your own stomach.

        Sad to see someone who is supposedly a medical professional buying into such rubbish.

        Posted by sleepydumpling | February 21, 2012, 8:40 pm
  11. Hi Jen,

    You seem to be arguing that positive portrayals of obese people will encourage further weight gain, implying that negative images and weight stigma are a motivating factor for people to lose weight. In fact, stigmatising people who are overweight and obese does not encourage them to lose weight. Weight bias has been shown to lead to behaviors such as binge eating, unhealthy weight control practices, coping with stigma by eating more, refusing to diet, and avoiding physical activity. Weight bias can also lead to higher blood pressure, more stress, and an overall poor quality of life (Haines et al 2006, Matthews et al 2005, Neumark-Sztainer et al 2002, Puhl & Brownell, 2006, Schwimmer et al 2003, Storch et al 2007).

    Negative media images of overweight and obese people have been shown to increase weight bias in society at large (McClure et al 2011) and more positive images such as those of plus size models are of great benefit in counteracting such bias.

    Furthermore, in a survey of 2,449 overweight and obese women, 69 percent said they had experienced bias against them by doctors (Puhl & Brownell, 2006). The consequences of this are that overweight patients are reluctant to seek medical care, delay medical appointments and put off important preventative healthcare services (Amy et al 2006, Olson et al 1994, Fontaine et al 1998). It has also been shown that doctors seeing overweight patients spend less time with the patient, engage in less discussion, and are reluctant to perform preventive health screenings such as pelvic exams, cancer screenings, and mammograms (Andreyeva et al 2008).

    You might be interested in the materials published by the Yale Rudd Center for Food Policy and Obesity regarding fat stigma in society. (http://www.yaleruddcenter.org/what_we_do.aspx?id=10) The Rudd Center provide an online toolkit entitled “Preventing Weight Bias: Helping Without Harming in Clinical Practice” – http://www.yaleruddcenter.org/resources/bias_toolkit/index.html. You may find it useful.

    All the best
    Emily

    References:
    Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for white and African-American obese women. Int J Obes Relat Metab Disord. 2006;30:147-55.
    Andreyeva, T, Puhl, RM, & Brownell, KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity. 2008;16:1129–34.
    Fontaine, KR, Faith MS, Allison DB, Cheskin LJ. Body weight and health care among women in the general population. Arch Fam Med. 1998;7:381-8.
    Haines J, Neumark-Sztainer D, Eisenberg ME, Hannan PJ. Weight teasing and disordered eating behaviors in adolescents: Longitudinal findings from Project EAT (Eating Among Teens). Pediatrics. 2006 Feb;117(2):
    209-15.
    McClure KJ, Puhl RM, Heuer CA. Obesity in the news: do photographic images of obese persons influence antifat attitudes? J Health Commun. 2011 Apr;16(4):359-71.
    Matthews KA, Salomon K, Kenyon K, Zhou F. Unfair treatment, discrimination, and ambulatory blood pressure in black and white adolescents. Health Psychol. 2005;24:258-65.
    Neumark-Sztainer D, Falker N, Story M, Perry C, Hannan PJ, Mulert S. Weight-teasing among adolescents:
    correlations with weight status and disordered eating behaviors. Intl J Obes. 2002;26:123-31.
    Olson CL, Schumaker HD, Yawn BP. Overweight women delay medical care. Arch Fam Med. 1994;3:888-92.
    Puhl R, Brownell KD. Confronting and coping with weight stigma: An investigation of overweight and obese adults. Obesity. 2006;14:1802-15.
    Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813-19.
    Storch EA, Milsom VA, DeBraganza N, Lewin AB, Geffken GR, Silverstein JH. Peer victimization, psychosocial adjustment, and physical activity in overweight and at-riskfor-overweight youth. J Pediatr Psychol.
    2007;32(1):80-89.

    Posted by Emily Walker | February 24, 2012, 6:00 pm
    • Thank you for your comment although it appears as if you must not have read my post.

      I mentioned that women of all sizes should have access to appropriate models/clothes. I stressed the importance of being healthy. I discussed that waist circumference of 35 inches or more is associated with increased health risks. I did not use negative terms to describe anyone of any size, but confined myself to the medical facts. Discussing health risks is not bias.

      In addition, it is interesting that Plus Model magazine mentioned health risks of being too “skinny” but did not discuss health risks of being “plus size.”

      To say that “everyone isn’t meant to be skinny” and “we are not talking about health” is just wrong. Skinny and healthy are two different things and while everyone isn’t meant to be skinny everyone is meant to be healthy, which means (for women, anyway) a waist circumference less than 88 cm or 35 inches, clearly not in the Plus Model Magazine demographic. And so the piece comes off as one big self-serving promotion for plus size models instead of an interesting piece on body image, why women feel “wrong” when they are overweight, why clothing designers neglect the plus size market, fitness (because you can be overweight and fit), and the difference between skinny and healthy.

      Posted by Dr. Jen Gunter | February 26, 2012, 9:50 am

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