On Wellness

The early Victorians had it all figured out. The science was clear; new research was being done all the time, refining and furthering the work that had begun in China. New institutions and societies were popping up everywhere to reform London. No longer did the poor have to waste away, shielded by nothing but superstition; the cause of disease was finally known, and simple, effective steps could be put in place to protect the populace. It was finally possible to separate good advice from bad: the bad advice was no more than superstition, while the good advice was consistent with the research. Truly, the 1850s were a glorious age, based on reason and science, unlike any before it.

Yes, the sanitary reformers of the time had the right idea: disease was caused by miasma, a sort of fog that emerges from decaying matter along with the smell. This miasma would seep into the body through the pores, wreaking havoc with the body’s systems and causing all sorts of disease. A miasma that caused Cholera in one man could cause a flu in another; it was all down to the individual’s constitution. The best way to fight miasma in a rapidly-overcrowded region was through sanitation systems: if waste products were kept covered, either by night soil or in water-driven sewer systems, nobody would take ill from them.

The research was abundantly clear: the London Statistical Society showed that urbanization lead to a dramatic increase in both morbidity and mortality rates. People were dying much faster in the nineteenth century than they had in the eighteenth, and it was no coincidence: they were exposed to far more miasma in London since the industrial revolution. The miasma had even become visible: thick, foul-smelling fogs were common, and the Thames was choked with nasty-smelling sludge. Edwin Chadwick’s research clearly proved that sanitation was the answer: putting in place a sewer system, avoiding places that smelled foul, avoiding the practice of using human waste as fertilizer, and covering the nose and mouth all helped keep the populace healthier. Submersion in water was written off as dangerous; to clean themselves, Victorians would uncover one small area at a time and sponge-bathe, being careful to dry the area before moving on. It was dangerous to go too long without washing, as the pores might become blocked and prevent the skin from breathing, but to go out in the miasma-choked air of London uncovered was virtually suicide. Surely, people would live longer and be healthier than ever before now that this was known.

Today, we know they were incorrect. Disease is not caused by miasma, but by germs, which often happen to live in places that are foul-smelling and filthy. But the research seemed to clearly support the theory, despite actually supporting germ theory; the two were similar enough that the results could be misinterpreted. It’s true that sanitation reforms saved lives, but further improvements, such as hand sanitizer, had to wait until the theory was corrected.

We like to think of ourselves much as the Victorians think of themselves: as advanced people, living in a society based on logic and reason alone, free of the superstitions of the past. While we have certainly come a long way since the Victorian era, it’s pure hubris to assume we’re now free of bias. We’re just as likely to make mistakes in medical theory as the Victorians were; we simply have more research in the past to base our findings on. Humans have not changed significantly, after all.

What if you lived in the Victorian age and you considered the idea that miasma theory was wrong? That it was, at best, imperfect? All around you, the advice you saw was based on avoiding miasmas. Nobody considered, say, avoiding someone with a bit of a cough as long as they didn’t smell “sick”. Nobody considered hand-washing to be of vital importance. Whole areas of research were neglected because they didn’t fit with the prevailing theory.

Look around you. What if being fat doesn’t cause illness? What if fat is fat and sick is sick, and while the two are sometimes correlated, there’s a confirmation bias in play convincing us the one leads to the other? What if the things that go along with being fat, like not exercising enough, binge dieting, and social anxiety cause illness? Can you find anyone, any single program, any single institute talking about “wellness” that doesn’t couch it in terms of weight loss?

These are the emails I’ve gotten from my workplace “wellness” program over the past few months.

This week:

Can one diet really lower blood pressure, reduce the risk of heart disease, prevent type 2 diabetes, and help you lose weight?! The DASH Diet makes the grade and is backed by a wealth of research. Read this week’s blog to learn what’s in the DASH Diet and get a sample meal plan.

Last week’s seems better on the surface:

It’s such a fun time of year! Delicious food, family and friends, and many festivities fill up our calendar for the next month. But, it can be a bit overwhelming when your health in on your mind. In this week’s blog we’re giving you our top tips for enjoying all this season has to offer, without going overboard.  

But the blog post was mostly around eating: what foods to avoid, what practices to follow to avoid “binging”, et cetera.

We’ve had a “steps challenge”, urging me to be more active so I can lose more weight. We’ have recipes posted in the breakroom, the bathroom, and on the blog. Front and center when I log in I a profile overview widget, proudly proclaiming my BMI, my weight, my weight change (apparently I’ve gained some weight), and my “wellness score”. If I click on the risk advisor, I get this lovely notice:


The “health assessment” says I’m at high risk for BMI, Cholesterol, and Emotional Health.

This is my favorite item:

While your diet is on the right track, you could use improvement. Try a few more fruits and vegetables every week, and a few less snacks.

The answers I gave in the quiz to determine how well I eat: I eat breakfast every day, I eat snacks a few times per week, I add salt to some meals (but not most meals), I eat mostly low-fat foods, I eat mostly refined grains, I eat four servings of fruits and vegetables a day, and I eat two servings of sugar a day (one sugary snack, and my morning tea involves sugar). And yet for that reasonable amount of moderation, I get smarmy messages about eating more fruits and less snacks, and a “moderate risk”.

Oh, and about all that sugar? My fasting glucose is in the low risk category. It’s perfectly fine. But I don’t eat 100% according to the guidelines of the day, so I’m “at risk” anyway.

Can you find better? What does wellness and health even mean outside the context of weight? I literally don’t know anymore. I have a vague idea about not smoking and getting a checkup every year, but that’s about it. What does it mean to be healthy, if not “thin”?

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1 Response to On Wellness

  1. Firedrake says:

    18.5? Bloody hell. Even for people who fit the profile, below 20 is dangerously thin.

    Anyone would think the categories were being defined to as to make sure enough people are “too fat”. Not that we have a weight-loss industry or anything. Oh, wait.

    “Pre-diabetes” is another recent invention: we can’t actually claim you’re diabetic, but maybe you will be one day, so we want to start selling you these drugs now

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