Although the health risks of obesity have been recognized for years, the true extent of these risks has only been realized in the last 100 years. Humans have spent most of their existence tackling malnourishment and famine. It’s only more recently that food has been produced in such abundance that we’re encountering widespread obesity and its consequences. Some have even suggested that our steady rise in life expectancy could soon plateau as a result.
Looking at mainstream media, you’d think gay men have escaped this issue, with slender, chiselled bodies the norm.
Yet some have rejected that ideal—and good for them! But ignoring your waistline can come at a cost.
As most people in the LGBT community know, the term “bear” refers to a diverse group of men who tend to have a huskier build. A movement thought to have started in San Francisco in the 1970s was built upon a rejection of the classic notion of the gay man as fashionable and slim. Some say it was strengthened during the AIDS epidemic in the early 1980s, when having a burly physique was interpreted as being healthy.
Today the bear community can act as a place of refuge, where guys who are far from model-perfect might feel a greater sense of acceptance. Here, obesity can be regarded as attractive—providing a deserved sense of self-confidence. Can there be a balance between accepting your bear-identified body and living a healthy lifestyle?
Pick a disease and you’re likely to find a study suggesting that it can be triggered by obesity. Heart disease and diabetes are what we often focus on, but there are many other related problems often overlooked. For instance, fatty liver is the most common cause of liver disease in Canada and has been directly linked to obesity. Osteoarthritis, a degenerative form of arthritis, is accelerated in those who are overweight, since it’s caused by wear and tear in the joints. The pain of arthritis makes exercise difficult and so the cycle of weight gain continues.
We also need to remember that excess body fat is not inert. It is biologically active tissue that affects the cells around it through hormonal and immune mechanisms. Some of these altered signals might be responsible for an increased risk of cancer and depression. It’s been estimated that it can reduce life expectancy in males by six or seven years.
So what are the obese—bears and otherwise—to do? Research examining the health benefits of weight loss is surprisingly unimpressive. Studies show a modest improvement in cardiovascular risk factors, mood, quality of life and mobility. Yet these are so well managed with medication that the additive effect of weight loss is often minimal. I’ve seen plenty of overweight guys who are very active and have excellent cardiovascular fitness. Their risk of death is about the same as slender guys who are equally fit.
So being thin might not have to be the ultimate goal—as long as physical fitness is a part of your routine. I’m not recommending packing on weight so you can enjoy a lifetime of cholesterol tablets. But for those who struggle to lose weight and just can’t seem to despite their best efforts, don’t get discouraged: The effort alone is making you healthier even if your size isn’t changing.
Yes, we know the risks, but what if obesity is tied to your identity, your sense of who you are and the group with which you identify? My advice is to be comfortable with whatever weight you carry. But that shouldn’t interfere with being healthy. Exercise, eat a balanced diet, and see your doctor to be screened for high cholesterol and blood pressure. And if you lose weight in the process, remember that the bear community is known for its acceptance and tolerance. Someone out there will appreciate you regardless of your physique.
Dr. Malcolm Hedgcock is a Toronto-trained family doctor living and working in Vancouver. He has a special interest in gay men’s health issues, including the primary care of those living with HIV and AIDS.