Lack of fat people hate on here.
(media.scored.co)
It's all three. Fat is also mid stream. There are causes of fatness but fatness also causes additional problems. Shitty diet plus poor lifestyle leads to obesity, fertility issues, diabetes, asthma, heart disease, blood pressure issues, heart issues, joint issues, trips and falls, bone fragility, and on and on and on. Then the resulting lack of productivity, income less households, etc tertiary effects.