Wednesday, March 17, 2010

Big may be beautiful - but is it healthy?

by Mark P. Behar, PA-C

I do not wish to portray myself as a "body nazi" or piss off bears and bear lovers, but I do have an issue with your having photographs of grossly overweight guys as somehow reflecting good health on your  otherwise sensational LifeLube and LifeLube.blogspot.

As a long time gay health activist since the mid-1970s and volunteer primary care  provider at a gay clinic and a long time family practice provider, it is  remarkable to me how many of our gay brothers succumb at a young age not of HIV, but of heart and lung diseases and complications of diabetes and other related coronary diseases.

Most of these conditions are very much in our control to prevent-- by avoiding tobacco, excessive alcohol  and other drugs, by eating healthier, by exercising more and losing weight. Almost every moribundly obese guy, except perhaps for a small subset of highly conditioned Sumo wrestlers, will have a combination of one or more problems that will most assuredly affect the quality and length of life by increasing the chance of cardiovascular events: high blood pressure, high cholesterol, diabetes, chronic lung diseases.  And many of us as we get older, we just get fatter!

Now I know there are always exceptions to everything medical people believe to be true. Genetics and environment play important roles in health and well being, as does attitude.  And, of course, everyone regardless of appearance, size, age, etc., deserves to be loved and have a relationship with someone.

But it would sure be great to accompany photos of extremely obese guys with information about why their obesity is not something to be emulated, but something to try to manage through exercise and nutrition.

Everything else about Lifelube and Lifelube.blogspot are outstanding. The information is thought provocative, the photos (even of the overweight guys!) is extraordinary, and the videos fun.

Yours in brotherhood,.



  1. Is being healthy the only goal in life? Should all desires, communities, practices, and ethics be subjected to the (hetero)normative gaze of Public Health?

  2. Trevor - I love you, but I just don't understand what you are talking about. Yes, I think being healthy is majorly important. And this idea that concerns about being overweight, or obese, are somehow heteronormative and and a product of big bad Public Health is just bunk. Please. We all know that being overweight can lead to all kinds of co-morbidities that can degrade or even destroy your quality of life, And yes, can kill you. How the hell is that heteronormative?

  3. As someone who has always argued that you can be big and healthy, there are always extremes which can be used to argue a point. Morbidly obese guys are as unhealthy as steroid abusing muscle mary's or anorexicly thin waifs, part of the discussion should be about promoting gay men of all sizes to feel happy and positive about themselves as a starting point for finding healthy balances that work for them.

    It's an interesting discussion to have, which is more dangerous being obese or smoking, the evidence I would suggest comes down heavily on the smoking as the biggest killer of gay men, yet it is a hell of a lot easier to bash the overweight and obese. Similarly is an obese gay man more or less healthy than a normal weight gay man who is addicted to crystal meth? I know it's not that simplistic as an either or, but there is in enough discrimination in the world without adding to it, and we should think more about how we can promote positive healthy role models for bigger gay men that can inspire them to become more healthy and manage their health.

    Obesity is a hugely complex issue, being a big guy myself I took the step of almost last resort and had a gastric band fitted because I had had two serious health scares, but it is a hugely hard journey and simply bashing guys for being obese doesn't really help them start on a journey of healthy change.

    Too many obese gay men crash diet or turn to drugs to loose weight because of the judgement of their peers and their mental health suffers and they don't achieve a healthy weight or outcome.

    We should build a health movement that goes further to understand the dimensions of desire and helps big gay men to be healthy and manage their health without outright condemning them or making blanket statements about what is healthy.

    Sorry bit of a ramble, but hopefully you get the point.

  4. Simone KoehlingerMarch 17, 2010 at 3:09 PM

    Not sure when expressing our concerns and encouraging each other to examine choices became the evildoing of public health.

    Questioning is good. And questioning the questioning is good. But it’s too easy to criticize an essay about weight by slapping on the “that’s heteronormative-and-therefore-doesn’t-apply to us” label.

    There is no way around it---being overweight is not healthy. This applies to straight people. And it applies to gay people. Does our size determine our goodness? Or how desirable or loveable or successful we are? No. However, talking about this does not mean that we value body image above all else.

    Thank goodness LGBT people come in all shapes and sizes. And thank goodness we let our ongoing fight for acceptance inform how we approach each other to talk about difficult things. However, LGBTs are not exempt from challenging discussions about health. What’s missing from everyday dialogue is nonjudgmental, honest exchange about our health and well-being---and why it matters. If we can’t have it among ourselves, when/where can we have it?

  5. This amounts to a claim that overweight people should not even be seen, because somebody else thinks they are unhealthy. As gay men, haven't we learned that shame is not a sustainable response to a health issue? As a public health practitioner I'd like to see the evidence that being overweight but otherwise fit is unhealthy.

  6. From the Centers for Disease Control and Prevention:

    Research has shown that as weight increases to reach the levels referred to as "overweight" and "obesity,"* the risks for the following conditions also increases:

    Coronary heart disease
    Type 2 diabetes
    Cancers (endometrial, breast, and colon)
    Hypertension (high blood pressure)
    Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
    Liver and Gallbladder disease
    Sleep apnea and respiratory problems
    Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
    Gynecological problems (abnormal menses, infertility)
    *Overweight is defined as a body mass index (BMI) of 25 or higher; obesity is defined as a BMI of 30 or higher.

    There is a lot more info at the above.

  7. Being and remaining healthy is certainly a major goal in life for most of us. Without good health, it is difficult for anyone to achieve a dream for the future, whatever that may be. In fact, this very concept of how we hope to see ourselves in the future is essential to maintenance of good health. Have you ever asked your gay, lesbian, and trans friends, patients, clients, what they see themselves doing 5 or 10 or 20 years from now? If we have no personal visions for a viable future, no hope for intimacy, or for meaningful relationships both short and long term, then why not party like there’s no tomorrow? Many of us may march “goose step” with our public health colleagues regarding advice about “safer sex” practices, which frequently ignores the challenge of anticipated life in the future.

    But what constitutes “being healthy”? Although that is one of the very features highlighted on Lifelube, most health professionals would agree on several things about what is not associated with enhanced quality and length of life for most of us:
    • Poorly controlled diabetes, high blood pressure, elevated cholesterol, asthma, depression, arthritis, and other chronic medical problems, all highly associated with being overweight. Many of these conditions contribute to erectile dysfunction, and thus indirectly, a need for continuing to seek out medications (such as Viagra, Cialis, Levitra) and other illicit drugs that may enhance sexual performance.
    • Smoking, and excessive alcohol and illicit drug use;
    • Poor nutrition (including inadequate vitamin D), inadequate exercise;
    • Driving recklessly without seat belts, without motorcycle or bicycle helmets;
    • Fishing or golfing during a lightening storm, etc.

    Overweight people absolutely need to be seen, and loved, and partnered (if they so desire), however pairing their overweight images with messages about exercise and nutrition is essential on a health blog. (Note I said “nutrition”, not “dieting.”) I would say the exact same thing if photos displayed anyone smoking, or “tooting” illicit drugs. Yes, it occurs in our diverse communities, but should not be glamorized. Many of us remember many of our gay and lesbian health colleagues who have prematurely passed on due to medical issues that we health care people have not well taught our constituencies or accepted as self-evident truths ourselves. We are diminished from their absence!

    There is plenty of evidence that merely being overweight, rather than being underweight, places people at increased risk for a lot of chronic health problems. And, as little as a 10% weight loss has been shown to have a positive health benefit. We currently live in a western culture in the 21st century, not in prehistorical times when being heavy did in fact enhance survival during environmentally challenging times—without the fast- and junk food and sedentary lifestyles common now. Jim is absolutely correct in referring to CDC’s reports about the association of obesity with many unpleasant chronic health conditions. This is not to say that all overweight people will invariably develop some or all of these problems. But I personally would NOT bet that a long and high quality life free from disability is in the future for most overweight people.

    Next time you’re in the mood, look at some of the “social networking sites” for older gay men. My guess is that you will see a preponderance of guys who are terribly overweight! We need to start looking beyond HIV and other STDs, and start thinking about health promoting lifestyles, that includes among other things, preventing the chronic medical problems associated with being overweight.

    Yours in brotherhood and sisterhood,
    Mark Behar, PA-C

  8. I am someone who is a non-bear partnered with a bear, who has serious health issues because of choices he makes around diet and exercise. I have found few places where this is discussed in ways that don't fall into binary, all or nothing thinking.

    This conversation is one that we in the gay men's communities simply don't do well. While the science is there that bears and bigger guys can indeed be healthy, you don't have to hang out at Bearbuck's or Hibearnation very long before the conversations turn to diabetes, CPAP masks that work best with facial hair, and knee replacement surgeries.

    Mark named the issue, and even with explicit support and appreciation for the larger men whose pics have graced this blog, he got some comments reinforcing the idea that this is a topic which is not open to discussion. It is not acceptable, it seems, to express any discomfort with health problems related to diet and exercise and mental/emotional health factors which go alongside. It is understandable that people whose bodies and sexualities have been regulated (including myself as a gay man in this) can get defensive, or hear even moderate positions as an affront or collusion with oppressive forces. And there certainly is a lot of body scrutiny and judgment in the gay men's communities. But I just don't see this going much beyond hurt feelings and misunderstandings if we cannot start to learn to talk about this topic.

    "Health at any size" is possible, but the vast majority of the time, it's not what is going on in the lives of men we love. Until we can start to hear each others' stories around how we inhabit our bodies, whatever their size or shape, this significant silence keeps us all disconnected from each other. And that's not healthy for any of us.


  9. I've been chewing on a response to this since it was first posted. A few things:

    1. It is good for everyone to define what a healthy life is for them, and for others to try to provide resources and support to make it happen. [This is why LifeLube's "How Are You Healthy?" campaign rocks!]
    2. You can't tell how healthy someone is by looking at them.
    3. Speaking from my own personal experience, I make better choices when I have some measure of acceptance and love of the body I'm in. The more I love it, the more I want to take care of it, and the smarter choices I make in terms of what goes in me.
    4. Additionally, one kicker of a point is what Daniel Reeders said on March 17, 2010. Shame never solved anything. What has solved some things is the practice of meeting people where they're at and encouraging any positive change they desire to undertake.


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