Fitness gear giant Nike recently unveiled a new plus-size mannequin in its flagship store in Oxford Street, London. While the move was initially hailed as a giant leap forward for inclusivity in sportwear, things quickly took a detour when critics’ comments sparked a social media furore.
Whether this was intentional or not, it made for good marketing of the brand, with searches of the Nike brand associated with the words 'plus size' growing by 387% and clicks on the mannequin's tights rising by 200% on British fashion retailer Love the Sales.
Plus-size mannequins - what's the fuss really about?
The flood of online comments and debate began when Tanya Gold, a particularly vocal British journalist commented in an article for The Telegraph that obese mannequins sold ‘a dangerous lie’. She went on to describe Nike’s new mannequin as ‘immense, gargantuan and vast’, adding that the mannequin wasn’t readying herself for a run in her Nike gear because she couldn’t run and was more likely pre-diabetic and on her way to a hip replacement. Some critics agreed, commenting that the message being sent was ‘unhealthy’ and ‘dangerous’ and that the mannequin ‘promoted obesity’.
The backlash to these comments was quick and intense with hundreds of women and various plus-size models taking to social media to denounce Gold’s ‘fatphobic’ comments, defend the mannequin and share how it had inspired them, making them feel welcome in the store.
Much of the criticism of the mannequin was deemed abuse, bullying and fat shaming of the plus-size community at large. Many pointed out that weight loss is not the only goal in fitness and that many plus-size women do, in fact, exercise and require appropriate fitness gear to do it in. Nike, it seems, is pioneering a much-needed solution in this marketing who previously had to be content with oversized sweats as workout gear.
While this should probably have been the end of it, the emotional arguments continued to rage alluding to the fact that Gold and other critics comments revealed a much deeper hatred of and prejudice against ‘fat women’.
The debate aside, Nike’s new mannequin does shine a rather glaring spotlight on a few hard truths and raises some important questions when it comes to health and wellness.
Nike's plus-size mannequin reflects a growing reality
While Nike’s mannequin may not be promoting obesity as some believe, it is a reflection of modern reality.
According the World Health Organization, global obesity has nearly tripled since 1975. In 2016 over 1.9 billion adults over the age of 18 were overweight, and of these 650 million were classified as obese. In addition, 41 million children under the age of 5 and more than 340 million children between the ages of 5 and 19 were overweight or obese1.
These figures indicate that weight issues are a growing problem for many, with 39% of men and 40% of women being overweight or obese. Obesity affects those in both the developed and developing world2. In medical circles it is considered a global epidemic.
The terms 'overweight' and 'obese' refer to an excess accumulation of fat. In clinical practice, doctors assess a person’s weight in relation to their height to estimate body fat. The body mass index (BMI) is an accepted standard measure when measuring whether a person is overweight or obese3. BMI is calculated as follows:
Imperial
BMI = 703 x Weight in pounds ÷ (Height in inches)2
Metric
BMI = Weight in Kilograms ÷ (Height in meters)2
In Adults4:
- A BMI of 25 to 29.9 kg/m2 is considered overweight
- A BMI of ≥30 kg/m2 is considered obese
- Obesity in adults is subcategorized as class I (BMI ≥30 to 35), class II (BMI ≥35 to 40) and class III (BMI ≥40).
The social and psychological effects of obesity
Once blamed for promoting stereotypes that were only representative of a very small minority, the media and advertising has, over the years, slowly begun to move away from a single form being ‘the ideal body type’ and towards inclusivity and acceptance that not all men and women look a certain way. Nevertheless, it is quite evident from the Nike plus-size debate that society at large may not have moved on as quickly.
What was clear from the discourse surrounding Nike’s mannequin was that many of the individuals regarded as being ‘overweight’ or ‘obese’ regularly felt attacked and bullied by the comments others made in reference to their size in some way or another. Some even mentioned the stares and comments that were made by ‘fat phobic’ people when they attempted to exercise or eat in public.
Gyms are intimidating places for most people, at least initially, even without anyone staring or making comments. Eating out is supposed to be a pleasurable, social experience. Having people comment on your size and whether or not you should be eating a certain meal or anything at all, completely takes the joy out of it.
The psychological implications of such behaviours can lead to increased self-consciousness, intimidation and isolation of the targeted individual. This often means that the person attempting to get fit or lose weight gives up attending gym and exercise classes, forgoes the healthy meal or avoids social engagements altogether. This can lead to feelings of hopelessness5, loneliness, anxiety and depression, which in turn can lead to weight gain6. No one of any size needs that.
The question of obesity, health and fitness
In the various online discussions people regarded as being overweight consistently mentioned people, including strangers, co-workers, friends and family criticising and bullying them and then telling them it was ‘for their own good’ an ‘out of concern for their health’.
One plus-size model even noted that because she was regarded as being ‘overweight’ she felt that her doctor didn’t afford her ‘proper care’. This was because he was more focussed than her current health complaint which was the actual reason for her visits.
Many of those commentating insisted they were fit and healthy regardless of their weight and some even shared photos of themselves participating in 10km runs or some form of exercise. Not all comments in response were kind and many were sceptical.
Could it be true that a person can be overweight or obese but also fit and healthy? To answer that one needs to take a few facts into account.
Obesity and disease
Research consistently shows that obesity is associated with an increased risk of developing the following disease and conditions4:
- Sleep apnoea
- Diabetes
- Hypertension (High blood pressure)
- Dyslipidaemia (High cholesterol and fats in the blood)
- Heart disease
- Stroke
- Cancer
This is why doctors will often address excess weight issues before addressing the actual reason for a visit when examining an obese patient. In addition, some countries and health insurance companies require them to do so in order to address these risks in an attempt to reduce costs. This is not always done because they wish to stigmatise, criticise or shame the affected individual, but rather because their primary focus is health. That said, some research does show that even some medical professionals have a bias against overweight individuals7.
The manner in which the subject of weight and the current concern a person is seeking healthcare advice for is addressed is of vital importance. When handled poorly by a healthcare professional, this may leave the patient feeling frustrated, shamed and as though they are not receiving the medical care they require.
The health profession has traditionally been trained to prioritise weight as the main determinant of health, because the majority of research shows a relation between excessive weight with health risks and the development of serious disease. In recent years, however, there has been a shift to a more inclusive approach that focuses on individuals overall health and wellness7.
This does not mean that weight issues will not be addressed where necessary, it just means that the focus has shifted from weight loss as end goal, to a more process-focussed approach where overweight and obese individuals are educated on developing sustainable healthy habits and behaviours such as7:
- Nutritious, balance eating
- Safe, pleasurable exercise pursuits
- Adequate hydration
- Adequate sleep and rest
This is something patients and particularly those who are regarded as overweight or obese should look for in their choice of healthcare professional.
BMI is not the only factor in calculating health risks
For the majority of people BMI is a good measure to assess body fat, whether one is overweight and is at risk for health issues. It is not, however, accurate for athletes, those who are muscular, short individuals or the elderly.
BMI along with waist circumference is generally a better indicator for the risk of developing obesity-related disease and conditions such as high blood pressure, heart disease and type 2 diabetes. In order to lower the risk of developing these diseases, people classified as overweight (i.e. those with a BMI of 29.9) and level 1 obese (i.e. those with a BMI of 30-34.9), should have waist sizes of8:
- Women: No more than 35 inches
- Men: No more than 40 inches
In those with a BMI of 35 or more, waist measurements are not a health risk marker.
Can you be overweight or obese AND healthy?
Research looks at averages and not individuals. So, while carrying excess weight is a problem for most people, it’s not always an issue for everyone. This is the because the human body is extremely intricate, and the development of disease or death as a result occur due to a complex mix of underlying factors. Obesity is also not a homogenous condition; it affects different people differently.
Some overweight or obese individuals do not experience the usual, unhealthy metabolic changes that others do. As such, they manage to avoid the usual pitfalls and health hazards generally associated with obesity, at least, temporarily. This group is referred to as the ‘metabolically healthy obese’9.
While there are no universal criteria to define the metabolically obese individual. However, some researchers believe that BMI should not be the only measure in assessing health. They suggest that even if an individual has a high BMI, they may be healthy if8:
- Their waist circumference is within the accepted limits: 40 inches for men and 35 inches for women
- They have normal blood pressure, cholesterol and blood sugar levels
- They have a normal sensitivity to insulin
- They exhibit good physical fitness
This team does warn that metabolically healthy obesity is not common and may not be permanent. Even if an obese individual is considered healthy according to the above criteria, this may change with age, a slow down in exercise or due the development of other lifestyle factors.
Can you be overweight AND fit?
Studies show that it is possible to be overweight and even obese AND fit, although this is more common in those with mild as opposed to moderate and severe obesity10. While being ‘fat’ and fit may seem like somewhat of a paradox, weight is not the only factor in judging a person’s fitness level.
In addition, overweight or obese individuals who are regarded fit based on cardiovascular measurements such as stress tests, have a reduced risk of developing cardiovascular disease in comparison to both unfit normal weight and overweight or obese individuals.
While being fit can reduce these risks, it is important to remember that it doesn’t necessarily mean and individual is completely healthy.
Bottom line?
The size of Nike's mannequins is not a problem. The debate they have sparked offers far more important insight into the real issues that should be addressed, especially when it comes to physical and psychological health.
There is a great deal of misinformation and misconception out there. It is definitely possible to be fit and overweight. More rarely, it is possible to be healthy and overweight. However, for the majority of people, obesity is not a harmless condition, especially over the long term.
Even if it doesn’t cause metabolic issues, it can damage to the joints over time, cause respiratory complaints and obstructive sleep apnoea. It also contributes to the development of numerous forms of cancer including liver, kidney, ovarian, endometrial and breast cancer, amongst many others11. It may also lead to a variety of psychological issues such as depression as a result of the social implications it causes. Those are the medical facts and anyone disputing them has research to do.
Regardless of these facts, overweight and obese individuals have as much right to dignity, respect and sensitivity as anyone else. It is our responsibility as a society to realise, honour and work towards actively practicing that, not just paying lip service to it.
While many may not realise it, most overweight or obese people have tried to lose weight repeatedly at some point in their lives. For many weight loss is not the ‘ultimate goal’ that others think it should be. This is not because they have given up, or are too lazy or don’t have the right attitude but rather because a person doesn’t need to be a size zero to live a happy and fulfilled life.
Being overweight or obese is also not as straightforward as simply eating too much or moving too little. Although these can be contributing factors in some cases, the body and psyche are far more complex than that and many factors can be at play. These also vary from one individual to the next so there is no ‘one-size-fits-all’ solution.
Negative comments, even when made with the best intentions, by anyone including medical professionals are not helpful or effective motivators. They only serve to intensify bias and stigmatisation, much of which is often internalised by person who is the target of the comments. Studies show that this can hamper weight loss outcomes in weight loss programs12. So as the old adage goes, if you can’t say anything good, don’t say anything at all. Rather focus on bettering yourself, identifying your own biases and working to eradicate these.
If you are truly concerned with obesity and health risks, you can make a positive contribution by studying and obtaining a relevant qualification and being prepared to offer the appropriate long term guidance and support that enables an overweight or obese person seeking help to follow through on the weight loss instructions they receive. This is severely lacking in most current weight loss programs13. Or become part of a positive social network of supporters that people can choose to engage with when attempting to address their weight issues.
For those battling the bulge that are concerned about the effects of excess weight on health, a mindset shift away from the societal ‘norms’ that are encountered daily is required. The focus should not be exclusively on weight loss using a single diet or workout plan. Research shows these consistently fail. Rather a concerted effort in making small, sustainable lifestyle changes over time that increase cardiovascular fitness to reduce health risks, the intake of nutritious food to fill and fuel the body, adequate hydration and rest periods should be made. If professional help is required, there are teams of doctors, nutritionists and fitness experts who take a more holistic, caring approach to assisting with making these types of changes.
Surround yourself with a helpful, positive community that supports your physical exercise endeavours, keeps you accountable but encourages you to carry on even if you miss a workout (or three) and generally makes you feel happy, supported and ready to do burpees (even if it’s just one).
References
1. Obesity and overweight. Who.int. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Published 2018. Accessed June 14, 2019.
2. Ng M, Fleming T, Robinson M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014;384(9945):766-781. doi:10.1016/s0140-6736(14)60460-8
3. Deurenberg P, Weststrate J, Seidell J. Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. British Journal of Nutrition. 1991;65(2):105-114. doi:10.1079/bjn19910073
4. Abdelaal M, le Roux C, Docherty N. Morbidity and mortality associated with obesity. Ann Transl Med. 2017;5(7):161-161. doi:10.21037/atm.2017.03.107
5. Murphy J, Horton N, Burke J et al. Obesity and weight gain in relation to depression: findings from the Stirling County Study. Int J Obes. 2009;33(3):335-341. doi:10.1038/ijo.2008.273
6. Schneider K, Baldwin A, Mann D, Schmitz N. Depression, Obesity, Eating Behavior, and Physical Activity. J Obes. 2012;2012:1-2. doi:10.1155/2012/517358
7. Tylka T, Annunziato R, Burgard D et al. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. J Obes. 2014;2014:1-18. doi:10.1155/2014/983495
8. Stefan N, Häring H, Hu F, Schulze M. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. The Lancet Diabetes & Endocrinology. 2013;1(2):152-162. doi:10.1016/s2213-8587(13)70062-7
9. Skerrett P. Overweight and healthy: the concept of metabolically healthy obesity - Harvard Health Blog. Harvard Health Blog. https://www.health.harvard.edu/blog/overweight-and-healthy-the-concept-of-metabolically-healthy-obesity-201309246697. Published 2013. Accessed June 14, 2019.
10. Do K, Brown R, Wharton S, Ardern C, Kuk J. Association between cardiorespiratory fitness and metabolic risk factors in a population with mild to severe obesity. BMC Obes. 2018;5(1). doi:10.1186/s40608-018-0183-7
11. Obesity and Cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q4. Accessed June 14, 2019.
12. Fruh S, Nadglowski J, Hall H, Davis S, Crook E, Zlomke K. Obesity Stigma and Bias. The Journal for Nurse Practitioners. 2016;12(7):425-432. doi:10.1016/j.nurpra.2016.05.013
13. Thomas S, Hyde J, Karunaratne A, Kausman R, Komesaroff P. "They all work...when you stick to them": A qualitative investigation of dieting, weight loss, and physical exercise, in obese individuals. Nutr J. 2008;7(1). doi:10.1186/1475-2891-7-34