Ok Shakespeare I’m not, but in fairness he was a poet and I’m talking science.
I was having a conversation with someone recently and we started talking about the show “Heavy”. I mentioned that my issue with the show is that I wish they would focus on increasing health through healthy habits rather than weight loss because the success rate of intentional weight loss is less than 5%. One person at the table said “that’s why diets don’t work – you have to make a lifestyle change.”
No. No No No No No NO NO NO NO.
First, to be clear, I am totally cool with people who want to diet and lose weight. I’m not trying to tell anyone how to live. However, since in their multi-billion dollar a year marketing campaign the diet industry works hard to cover the fact that they have a less than 5% success rate, I think that many people might not know that. And since it stands to reason that a big part of the why the diet industry keeps making so much money is that 95% of people fail and a lot of those people blame themselves and turn around and start another diet, the industry has a vested interest in making us believe that the blame lies in the 95% of people who aren’t able to change their size over the long-term. And so a lot of people don’t realize that the diet they are embarking upon is an endeavor that:
has a greater than 95% chance of failing
hasn’t been proven to make them any healthier
has serious health risks.
So I thought I’d just put it out there.
For the record this isn’t just a fat girl thing. I would be just as angry if 95% of people who took antiobiotics still had strep throat and they were being told that it was their fault. Or if Viagara only worked 5% of the time and doctors were blaming the other 95% of guys for not trying hard enough.
Bottom line, if you attempt to make your body smaller on a long-term basis, then you have a less than 5% chance of success. You could call it a diet, an eating plan, a lifestyle change, a health plan, or a whizzywoo, you are still trying to decrease the size of your body over the long term and therefore you still have a greater than 95% chance of failure based on the best science available.
Again, I’m not trying to tell people whether to diet or not, I absolutely respect anyone’s choice, but I do think that dieting deserves a disclaimer.
I witnessed a conversation between two people I’ll call Ben and Angie. In the context of the conversation, Ben guessed that Angie weighed 150lbs. She immediately said “No way, add 50 pounds to that”. He said “I know, I was trying to be nice”. She said “It’s ok, it’s a compliment”.
This is not the first time I’ve heard this conversation, it’s happened to me. I think that it’s pretty common when weight is involved. I see some issues here:
I’m going to go out on a limb and say that purposely misrepresenting someone should maybe not constitute “being nice”, since what that really seems to indicate is that you think that what they actually are is not ok – that it is something to be ashamed of and lied about.
It’s fine for Angie to feel that it’s a “compliment” that someone purposely misrepresented her to be nice. Angie is the boss of her underpants and allowed to choose whatever life experience she wants.
However, I think that in the meta-analysis, someone purposely misrepresenting who you are as a way to be “nice” probably only works in this situation because we live in a culture that thinks that thin is the most valuable thing, and we choose to buy into that point of view. Even if someone thinks it’s a compliment in the moment, I wonder what the effects are of hoping that, and being happy when, someone is “trying to be nice” by guessing your weight at 50 pounds under what is true, considering that you’re living in a body that’s shown actual size.
Imagine if the conversation had been about something else – race, ethnicity, religion…even hair:
Ben: “Angie, you have beautiful straight hair.”
Angie: “No actually my hair is really curly, look, you can see it curling”
Ben: “I know, I was just trying to be nice”
Angie: “Thanks, that’s totally a compliment”
Not so much.
When I identify as “fat” and people freak out – as they often do- they honest-to-god will say “You’re not fat”.
Instead of asking them “how many fingers am I holding up” I’ll sometimes say “No, I’m definitely fat – I weigh 284 pounds”. They most often respond “No way , I thought that you were no more than 150 or 175.”
Ok, that’s crazy talk. I do not look more than 100 pounds lighter than I am. But I don’t know if people really think that I am what 150 pounds looks like, or if they are just “trying to be nice”. If it’s the latter then let me just be clear that I don’t think it’s a compliment to lie to me. Of course another option is that what they are saying is “You don’t fit my stereotypes of fat people” – but that’ a whole ‘nother blog.
Just for the record:
This is what 284 pounds looks like (c’mon, you’ve got to admire all the ways I’m finding to work these pictures into this blog…)
I am 284 pounds of healthy athlete and I am proud my body and every single thing that it can do. You lying about my weight is not “being nice”, you’re either telling me that I should be ashamed of my weight, or you’re trying to shove your weight insecurities on me. Either way, I’ll pass.
If you want to be nice to me then show some respect for who I am, what I look like, and what I can do.
Yesterday in response to my post about being disappointed with Lane Bryant for using models whose size precludes them from actually wearing Lane Bryant clothes, I received several replies saying that Lane Bryant has run tests and plus-sized women bought more clothes when they were advertised on a “straight sized” model than on an actual plus-sized model. What with the who now?
So I did some quick (very quick, I left the house at 8am and just got home an hour ago) research. According to a controversial study from Arizona State University:
“We found that overweight consumers demonstrated lower self-esteem – and therefore probably less enthusiasm about buying products – after exposure to any size models in ads (versus ads with no models). Also, normal-weight consumers experienced lower self-esteem after exposure to moderately heavy models, such as those in Dove soap’s ‘Real Women’ campaign, than after exposure to moderately thin models.”
Here’s my question: Do you think it just might, maybe, possibly be because we have been so aggressively sold the idea that there is only one body type that is beautiful that we’ve started to believe it, and so as a culture when we see someone outside of the single image of beauty that we are sold 99.999999999% of the time we experience a conditioned response and immediately think “That’s a bad body. That body is wrong. My body is like that. My body is wrong.”?
Instead of looking at this study, asking the question that I asked, and pondering their culpability in the situation, what I see the media and advertisers doing is hiding behind the study and continuing to perpetuate their singular idea of beauty on the grounds that we like it better, which continues to reinforce that any body outside of that ideal is somehow unworthy of being seen, which means that we like the “ideal” more, and like our own bodies less. Especially in a world where we almost never see an image that has not been so “retouched” that it is a completely impossible standard of beauty. Does this seem like a good idea to you? I think it’s pretty much crap.
I find bodies of all shapes and sizes beautiful – I always have. I guess if I’m truthful I’ve always been more interested in the present than that box it comes in, but I’ve been purely physically attracted to all shapes and sizes of bodies. I feel very lucky in that respect – even when I couldn’t find appreciation for my own body – I could always find it for the bodies of others. And I think that if we truly want a body revolution, then we’re going to have to get it done ourselves.
My first suggestion:
Seek out pictures of bodies of all sizes, look at them every day. Find things about them that you like. Start to really look around you at the diversity of bodies that exist. Realize that every single body is doing amazing things – the owner of the body isn’t even thinking about it, yet in every one of those bodies a heart is beating, lungs are breathing, eyes are blinking. Millions of processes are going on every second in every body. They are amazing machines at every single shape and size.
Decide, right now, that you are above putting down other bodies to make you feel better about yours (even if you only think it), or for any other reason. Start to notice any time you think anything negative about anyone’s body and stop yourself and replace it with a positive thought. Refuse to participate in body snarking with other people. Be the change you want to see in the world.
Just in case you’re not in the know, Lane Bryant is a store in the US that caters to plus-sized women. Recently they ran a “Curvy Revolution Contest”. They gave women the opportunity to show off their best runway walk in a one minute video and win a chance to walk in the Lane Bryant Curvy Revolution fashion show in Vegas.
I’ll tell you right now that I have a some skin in this game, although not my skin. This probably wouldn’t have been on my radar at all except that CJ Legare is a dear friend of mine. She is the second place winner.
Let me also state for the record that I’ve been competing at something or other almost all of my life athlete from way back, I’m currently a competitive dancer and I know full well that sometimes you just get beaten. Sometimes your best isn’t good enough. Sometimes it really is an honor just to be nominated. So at first I thought – Second Place…HELL YEAH (10 points if you know the movie reference). But then I saw the winner and first runner up.
CJ is a pro and is taking this gracefully. I am not. And here’s why:
First of all, the rules include that there could be no pre-recorded music, no designer labels and that 75% of the score was based on “creativity, perceived personality, vitality and inspiration of entrant …The Grand Prize selection will be subject to verification, including without limitation, verification of eligibility, compliance with these Official Rules”
Ok, the winner and runner up both have pre-recorded music, the second not only has a designer label but the emcee POINTS IT OUT.
Thousands of other women turned in videos that could have been improved with pre-recorded music and designer clothes and accessories, but they didn’t include those things because they reasonably believed that they would be disqualified if they did.
Lane Bryant says that it’s not their fault, they outsourced the final decision to a modeling agency. Their stance is that their rules were copied from somewhere else and were therefore not important. (Apparently they are like the Pirate Code – really more like guidelines anyway. 10 points if you know the movie reference). My stance is that it’s your damn contest so if you don’t have the balls ovaries to make a decision, then that IS a decision, and you are responsible.
But those are little things compared to what I think is the greater issue here. I adore CJ and of course I wanted to see her win. But I was also excited about the idea of having a truly plus-sized model, a model who could shop for clothes at Lane Bryant, walk down the runway. Except I didn’t really get one. And I was left asking – why would Lane Bryant break all of their rules for those two girls? It looks to me like neither of them could even shop at Lane Bryant. When I look at their website, it seems like part of a trend.
This is my friend CJ. She is a plus-size model and is a size 18/20. She can shop at Lane Bryant:
Here is a model who is on their website right now. I’m not linking because I’m too irritated to help them get any internet traffic:
How is that plus? How does that reflect their customer base?
One of the models below is a straight sized model from the New York and Company website and one is a “plus-sized” model from the Lane Bryant website. Can you tell which is which?
The one in the white shirt is the straight sized model, the one in the green is plus-sized.
There are a few conclusions that I can draw from this, none of them good, and I’m not sure what is actually true:
1. Lane Bryant would love me to spend my size 26/28 money there, but they are too ashamed of the way I look to show women who look anything like me in their clothes.
2. Lane Bryant thinks its fun to disappoint plus-sized women and make them feel bad about themselves by creating a public image of their clothing that cannot possibly be recreated on the plus-sized women to whom they sell those clothes.
3. Lane Bryant thinks that fat women hate our bodies so much that we can’t bear the sight of ourselves and therefore will only buy clothes if they are sold on a non-plus sized model so that we can commit the fallacy in #2 wherein we believe that these clothes will make us appear not plus-sized. Maybe seeing clothes that have been altered to be worn by women much too thin to fit into them is what the majority of plus-sized women want to see. Even if it’s true, here’s the huge problem with Lane Bryant’s approach.
If you think about it, almost every normal activity that we see on commercials, billboards, magazines etc. is being done by a thin women. We keep hearing that over 60% of the people in this country are “overweight” or “obese” (a statement of questionable accuracy for me to deal with another time). We are the majority. We control the vote in this country. But if the only thing I knew about this culture were movies, billboards, commercials and television shows, I would think that almost everyone was thin and the rest were successfully losing weight. And Lane Bryant, which could be a bastion of positivity showing plus-sized women looking confident and fabulous, instead opts to alter their clothes to fit women who will never pay them any money because they do their shopping at the vast array of stores that carry their sizes, not the the very few stores that carry my size, and that’s disappointing to me.
I just worry that your are confusing the two and have convinced yourself that 284 is healthy. I guess I would challenge you to post your numbers (cholesterol, Blood pressure, etc) and prove to the scientific community that larger people can have perfectly healthy numbers. That would make it easier to shut these fat-haters up!
He/she prefaced this with a paragraph that I found even more paternalistic and insulting. You can read my answer on that post, but what it made me want to talk about is the double edged sword of proof as it relates to us fatties.
Obviously, the fact that I am healthy is not enough proof for the scientific community (nor should it be) – but I have to wonder what would be enough? So grounded are they in the apocryphal idea that health and weight are causally linked that it seems like no amount of evidence will sway them. I know that because we keep reading things like “[random health problem] is caused by obesity” even though there is zero evidence to support those statements. The bigger problem to me is that this has lead to a climate where instead of trying to figure out what would make everyone healthier, everyone is trying to find the magic bullet that will make everyone thin.
You would think that after all of this time and effort, the fact that they have failed to prove that weight causes health issues, or that intentional weight loss works, would have lead scientists to start looking for another answer, or at least a new question. Unfortunately very few people seem to be interested in doing any research to see if the issue might be something other than weight perhaps because they are too busy trying to shout “don’t you know fat is unhealthy” above the noise of the actual evidence.
Maybe it’s because convincing people that being thin will make them healthy has become a $60,000,000,000 a year industry. Who wants to give up sixty billion bucks to research the health effects of being constantly told that you are sick, unattractive, lazy etc. Or to research why it is that in countries with no stigma about obesity there seem to be no greater negative health outcomes. That would be too much work. Just keep telling the fatties to lose weight. It’s a great business plan since intentional weight loss (whether you call it a diet, lifestyle change, eating program, medically supervised, or something else) fails 95% of the time within 5 years. (Even if you see a doctor, even if you lift weights to increase your base metabolic rate, even if you only lose one pound per week…) This revolving door affords the industry a never ending supply of clients. They seem to think that diet programs are like toilet paper – you’ll need them every day until you die.
So it seems that no number of healthy fat people would satisfy the scientific community that you can be fat and healthy, especially in light of the VFHT (Vague Future Health Threat) Maybe some scientist would like to explore the possibility that it’s not the obesity that “catches up to us”, but the stress of a lifetime of constant social stigma, discrimination, and assertion that we are unhealthy lazy slobs, that causes health problems later in life for some obese individuals.
On the other side of that equation are these diets we keep hearing so much about. They work less than 5% of the time. But the general consensus of the scientific community seems to be “They only work a tiny percentage of the time, but that’s proof that they work so go get ’em tiger. And if you find yourself in the 95% of people who don’t lose weight – it’s so obviously and scientifically your fault. 5% of people can’t be wrong!”.
So every scientist and researcher interested in this subject has the opportunity to study the 1 in 3 healthy obese people and try to figure out why they are healthy. Or to study cultures where obesity is not stigmatized and negative health outcomes do not appear to be realized. Or they could do the million and first study about weight loss and the less than 5% of people who’ve been able to maintain weight loss for more than 5 years. And most of them choose the latter! I don’t think I’m particularly interested in the opinions of people who call themselves scientists and yet continuously make that choice.
All scientists make mistakes, disprove their own hypotheses through their research, and realize that they were wrong. That’s what science is about. It just seems like the ones who aren’t part of a $60 Billion industry are a little quicker to be honest (and, you know, scientific about it), and make a course correction. I don’t know about you but 5% is within the margin of error of most studies and that’s just not enough proof for me. What I do keeps me healthy and Monty may be worried about me (“bless his/her heart” as we say in the South), but I am not worried at all.
Health is not an obligation, a barometer of worthiness, a guarantee, or entirely within our control. One of the major variables is access. Access includes a number of things. (I’m going to use HCP to mean Health Care Provider, including whatever health care someone might choose – doctors , nurses, hospitals, acupuncturists, chiropractors, homeopaths etc.)
Ability to get to the HCP
This would include proximity, transportation, ability to get time off work, to go, or ability to visit before or after work, being able to meet the requirements that your insurance has for you to see the appropriate HCP, being able to get an appointment with the HCP you desire to see.
Ability to afford the HCP
Can you get insurance? (Before the affordable care act, I wasn’t able to get insurance because companies were allowed to exclude me because of my size). Can you afford the insurance? If not can you afford the cost of care without it? If yes, does your insurance cover your health issues? Can you afford the co-payment? Can you afford any medicines prescribed? Can you afford follow up care, physical therapy etc. Can you afford to take off work if necessary for the treatment?
Ability to get good care from the HCP
Doctors ability to give good care can be hampered by their own stereotypes, preconceived notions and prejudices. It can also be hampered by what they can afford in their facility. This is where we fat people can have some serious issues. Rebecca Puhl, a researcher at Yale University, does a great deal of around obesity and discrimination. In one of her studies 24% of nurses said that they are “repulsed” by obese persons. Also more than half of the 620 primary care doctors questioned described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.”
I have personally had doctors try to put me on blood pressure medication before taking my blood pressure (it was 117/70), and look at me and mis-diagnose me with Type 2 diabetes without doing any testing. I’ve overheard my doctor tell my nurse that she should use the large blood pressure cuff instead of the extra large because “if we use the right cuff her blood pressure is normal. A too-small cuff will show high blood pressure and maybe that will scare her into losing weight”. I’ve had doctors prescribe weight loss for a broken toe, separated shoulder, and strep throat. I hear stories all the time from people who have been diagnosed as “fat” by their doctors when they have real health issues that could easily be treated.
In order to truly have access to healthcare fat people must first be willing to go to our HCP – if that HCP is a doctor then we have to be able to go in knowing that there is a more than 50% chance that the person we are coming to for health care will think that we are “awkward, unattractive, ugly, and unlikely to comply with treatment”, and an almost 25% chance that the nurse we see will be “repulsed” by us. Even if they are not part of that group, there’s a good chance that no matter what we go in for, we are getting a lecture about our weight, and if we practice Health at Every Size, we are probably going to have our research and choices dismissed as ridiculous by someone who is recommending a solution that almost never works.
If we can get over that, we have to find a doctor who won’t let his/her personal weight bias get in the way of actually treating us for what is medically wrong. Based on my own experience, my fat friends’ experiences and the stories that I’m reading all over the blog-o-sphere that is much easier said than done.
I wonder how many of the incidences of major health problems in obese people are due to the fact that going to the doctor is such a stressful, humiliating, and ultimately useless experience for us that we don’t go until our minor medical problem has become something major? How many people miss out on early diagnosis and early cure of issues because they couldn’t bear to be humiliated and lectured at their annual annual physical, or they don’t get a proper examination because the doctor is convinced that weight loss is some sort of snake oil cure-all. How many people don’t go get follow up x-rays because they just can’t bare to put themselves through the process of being naked in front of someone who is repulsed by them. How many people gave up on doctors because no matter how healthy our habits were, we were called liars if we claimed to be anything other than sedentary over-eaters.
One of the lines in a widely used version of the hippocratic oath is:
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I cannot find a version of the oath that includes “unless I find that patient ugly, unattractive, and awkward”. So no matter what his/her personal weight bias may be, doctors appear to have agreed to treat us with warmth, sympathy and understanding. I think it’s time that starts happening.
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I am a big, fat nerd, in every sense of that phrase.
I research everything, I read a ton, I look up words I don’t know and use them until they are part of my vocabulary – call me perspicacious.
I am also a person who takes her health very seriously.
So, when it came time to decide on a path to health, I didn’t select randomly, or base my choice on a motivational commercial, or on what a newly thin actress had to say. As much as some people would have you believe, I also didn’t choose a path to health that I thought would “justify my fatness” or “permit bad behavior”. In fact when I started looking for a path to health, based on everything I had seen and heard I assumed it would involve losing weight.
My research of diets found that the conclusion of diet studies that looked at long-term success was basically: “this hardly ever works, but it’s still worth trying because of all the health problems caused by obesity.” Further research showed that the “health problems” had never been shown to be caused by obesity and weight loss had never been proven to solve any health problem. In fact the only thing that weight loss had been proven to do was, well, make you weigh less. But even that was a short term effect, with long-term success rates so small that they were within the studies’ margins of error in most cases. (Here is an article that researched weight management articles and found the same things that I found.)
I also started to notice the small print on every single diet ad: “Results Not Typical”. Hmmmm. I pondered this question: If I went to the doctor because I was sick and she said “Take this medicine, it worked for Tammy. Of course, her results aren’t typical. In fact, it only works about 5% of the time, the other 95% people end up more sick than when they started…” what would I do? I determined pretty quickly that I would absolutely NOT take the medicine.
My previous history with dieting matched what the research showed me I should expect. I would lose weight at first, then plateau, then gain it back plus more. So if it wasn’t dieting, what was it?
I found Health at Every Size (that’s the term I’ve come to know it as now) and Intuitive Eating by accident. I starting researching further and I chose it for five main reasons:
1. It suggested that to be healthy, one should concentrate on healthy habits.
That seems like a big flaming sack of duh now, but back then it was revolutionary. It was a face-palm moment. I had been thinking that the best way to improve my health was to change my body size because being thin was proven to be correlated with health. But being trained in research I knew that correlation never EVER implies causation. So from a scientific perspective, trying to be healthy by losing weight is like trying to heal a broken ankle by cutting your hair because you’ve heard that people with short hair have been shown to have less broken bones. It seemed to me that if you want to heal a broken ankle you choose behaviors that will facilitate healing (get a cast, stay off it etc.) If you want to be more healthy, choose actions that facilitate health.
2. It suggested that I should check my health to begin with.
Another no brainer that had never occurred to me. I started to look into it and it turns out that the doctors who had told me that I NEEDED to lose weight for my health had neglected to tell me that the health I had was damn near perfect. When confronted they gave me the Vague Future Health Threat and the same lines that I had heard in diet ads,which was a HUGE red flag for me since it meant that they were either giving medical advice without having studied the research, or they were medical professionals who don’t understand the difference between correlation and causation which, as far as I’m concerned, makes them unqualified to pull a splinter out of my toe.
3. It meant that I could maintain a good relationship with my body.
I think that the biggest lie that we’re sold is that our “weight” is somehow different from, or separate from, our body. In truth it seems pretty clear to me that our weight is part of the body that we inhabit 100% of the time. So if I am fighting a war with my weight, then I’m at war with my own body. If I’m struggling with my weight, then I’m struggling with my own body. If I’m motivated to lose my “embarrassing, ugly fat” then I am embarrassed by my own body and think it is ugly. It is unacceptable to me to be in a bad relationship with the body whose heartbeat and breathing keep me alive, whose limbs get me where I want to go, and whose brain allows me to do pretty much everything.
I grew up believing that my body was a limitation to be overcome through mental toughness. Through my journey I had learned that my body is a partner and friend that deserves respect and good treatment. Health at Every Size was the only program that allowed me to treat my body with respect instead of viewing it as broken, flawed, and something to be disgusted by, embarrassed of, battled against, struggled with, and changed by whatever means necessary.
4. It made allowances for the multi-dimensionality of health
All of the diets that I had researched seemed to assert that to be healthy you should focus on your weight, and that your weight is all a matter of behavior. Considering the complexity of the human body, that seemed pretty doubtful. Based on my research I believe that health is some combination of: Genetics. Environment. Behaviors. Access. Health at Every Size taught that I could focus on the aspects of my health that I could control, rather than feeling like a guilty failure for things that were beyond my control.
5. I could be wrong
Every good scientist will tell you that they might be wrong. It’s a basic tenet of science (another reason that I found all those diet ads pretty fishy). So I knew that whatever path I chose, I could be wrong and would have to live with the consequences. Having spent most of my life dieting and hating my body, I had a pretty good sense of what a lifetime of that would entail. At the point in my life that I was making this decision, I could just start to imagine a life that wasn’t dictated by a scale, calorie counting, hating my body, and yo-yo dieting. I realized that even if my choice was so wrong that it caused me to die in 40 years instead of 60, I would rather have 40 years living a Health at Every Size life than 70 years living a diet/weight loss lifestyle.
So here I am, many years later still healthy, still “Type 3: Super Obese” (and where the hell is my cape?!). I was going to compare it to my life of dieting, struggling with my weight and hating my body, but the difference is so sharp that there simply is no comparison.
I would never go back. And now that I’m on the other side, I want reach as many people as I possibly can and tell them that that this life is an option for them to. To be clear, just as I demand respect for my choices, I respect the choices of others. I don’t believe that anyone has to make the same choice as me, and I’m not trying to convince anyone, but I do believe that everyone should know that the option exists.
For more information I recommend you check out Linda Bacon, who literally wrote the book on HAES: