I talk about the fact that my metabolic health indicators are all really good and so I get asked a lot “What if you get diabetes/heart disease/sick?” This is known as the Role Model Problem – the idea that if we hold someone up as a “role model” – proof that fat people can be healthy – then if that person gets sick it’s proof that fat people can’t be healthy.
The truth is that neither statement is true. The fact that I am healthy is not proof that all fat people can be healthy. If I were to get every obesity related disease tomorrow it would not be proof that no fat people can be healthy. There are healthy and unhealthy people of every size.
The problem as I see it is that in our culture we’ve completed confused the concepts of weight and health. Somehow we’ve forgotten that body size is NOT a diagnosis.
There are exactly two things that you can tell from the size of someone’s body:
- What size they are.
- What your own prejudices and preconceived notions about that size are.
Health is multi-dimensional and not all facets are within our control: current behaviors, past behaviors, environment, stress, genetics, and access – including access to nourishing foods, movement options that are safe and enjoyable, and good health care which we know can be an issue for fat people.
Our numbers aren’t entirely the result of our behavior, in some cases they are primarily the result of factors outside of our control. We know that marathoners can drop dead of heart attacks. Again – there are healthy and unhealthy people of every shape and size.
To answer the question, if I were to have a health issue then I would treat it from a health perspective. Somewhat unbelievably to me, that would likely be a controversial choice. Consider this:
Typically if a 120 pound woman goes to the doctor with high blood sugar, she is given health interventions that are known to control blood sugar, then in subsequent visits her blood sugar will be measured to test the efficacy of the treatment. The treatments that she is given will be proven effective before they are prescribed to her and if they fail her case will be re-evaluated and new interventions prescribed.
If a 300 pound woman goes to the doctor with high blood sugar, she is told to lose weight, and in subsequent visits her weight will be measured to determine her success. Based on all available research this treatment fails 95% of the time. If the treatment fails she will be blamed for not doing it right and assigned the same treatment again.
How does that make sense? Why is a thin person given interventions that are related to their health problems, but a fat person is given interventions related to their size? If a thin person can have diabetes then being thin can’t be the cure. Confusing weight and health does a disservice to everyone.
So if I get sick I’ll look for interventions that have a likelihood of making me well. But for now, thin people aren’t required to prove that they will never get sick in order to celebrate their current good health and I won’t live by a double standard. I’m 34, fat and healthy. Yay! Someday I will be dead. In between I’ll do the best I can with my circumstances and my body.
Dances With Fat 
You simply amaze me with your self confidence and positivity. I wish I could feel that way rather than how I do feel right now.
Great article, Regan! As you know, I was denied health insurance because I am a woman who weighs over 250 pounds. It doesn’t matter how tall I am. If I was a man, no matter what height, I could weigh up to 300 pounds and still be covered. Other than my slightly low thyroid, all of my blood test results were fantastic. But I guess that doesn’t matter.
On the other hand, my dear 80 year old mother is underweight. People harass and scold her in public because of it. She doesn’t want to be 115 pounds. It’s just the way her body is. A few days ago she was getting a flu shot at a pharmacy. The woman giving it to her poked at her protruding collarbone, and squeezed her thin arms, scolding her for being so thin. My mother spoke up and said “I would prefer having a voluptuous body like yours but this is the body I have been given.” That shut her up!
I remember when I went to see a pulmonologist once about a spot on my lung that was found at the same time as the ovarian cancer I spoke of in my last comment here. He tried to sell me on going to his weight loss clinic. (What is wrong with this picture?!)
He asked, “Do you get pain in your joints?”
I said, “Yes, the joints in my hands bother me.” Which, from the look on his face was not the response he was after.
He asked, “Well, have you noticed how you never see any old overweight people?”
I said, “I see one every day. My dad is in his 80’s and is well over 300 pounds.”
He shut up. I found another pulmonologist.
I once overheard the director of the physical therapist clinic that I went to try to sell his weight loss plan to an electrician. (actually, it was some other weight loss plan that I’m SURE he was being paid to shell out) The electrician responded “uh huh… the problem is with your ballast, not the lamp.” I smiled.
I just found your blog this week. I am a BIG gal, 55 years old and have struggled for years. I have told myself that my size is fine, but I realize that I have been lying to myself. And then I discovered you… wow, big change in the way I am looking at things, plus you are really funny. I have diabetes, HBP and while I have been given some meds and insulin, it isn’t working. The more I stress the more I eat. And the doctors just keep tut-tutting and tell me to lose weight. HELLO – I know more about nutrition than they do! Am I really choosing to kill myself? No, I am not, I want to be healthy. I have YEARS of food issues. Your blog is wonderful. Thank you. I will try to focus on being healthy and just being who I am.
XO
When I see a doctor for the first time, they usually do blood tests and then when I return they look amazed that my BP, cholesterol and sugar levels are, shock, horror, awe, NORMAL. I have had some higher BP levels recently, but have got it back into normal levels with walking. I will simply not deal with a doctor who focuses on my weight, it’s lazy and insulting.
Yep, my current primary care provider remains my provider because — though she seemed somewhat surprised when my numbers came back healthy — 1) she hadn’t lectured me about my weight beforehand; 2) she didn’t seem to take it as a personal affront that my weight/other numbers didn’t match what we’re often told about weight and health.
Additionally, aside from asking me about diet and exercise (neutrally, and believing my answers), she’s never mentioned weight-related things during any of my visits.
It’s good, yes. But on a grander scale, it perturbs me that even the most fat-friendly providers I’ve encountered are surprised (though not suspicious) that fat can sometimes be healthy.
A couple of years ago, my normally low blood pressure suddenly shot up considerably. Fortunately, I had a fairly fat-friendly medical professional who was interested in monitoring the situation and looking at various possible causes, instead of going “Yep, the fatness finally caught up to you.”
It turned out to be a reaction to certain over-the-counter decongestants, and once that was out of my system, the numbers dropped back to low-normal. A doctor who thought blood pressure was automatically about fatness never would have caught that, as the results would have been either “Diet!” “No!” “You’re gonna die!” or “Diet!” “Okay!” “You fail at dieting! Bad lazy fat person!”, with no room for “Weight loss doesn’t actually cure this. Let’s check for other things!”
And then we have my sister, who is offended as all hell that her doctor *doesn’t* focus on her weight. Doesn’t even seem to think about it!
I keep telling her she can ship her doctor up here and I’ll take her, and she can have my last doctor (since I don’t currently have one, having no health insurance and nothing wrong enough that the ER would give me the time of day… even if I could pay for it). He wasn’t the worst doctor I’ve ever had, but of course he had to prescribe weight loss constantly. “We need to get you walking!”… erm, what does he THINK I do? Don’t answer that, we all already know
It is not all that simple. You are right that thin people are not necessarily healthier than overweight people, and there are a lot of really healthy overweight and obese people out there, BUT…
Weight is not the problem. You are right there. But with many diseases, the behavior that leads people to gain weight is also the behavior that sets all kinds of other mechanisms up for failure. Like eating junk food with loads of sugar will most likely mess with your insulin production, while you gain weight from eating all that sweet food. Which will lead to diabetes, which can lead to all kinds of nasty complications. (I am a medical translator at an office that mostly deals with patients from Middle Eastern countries, where obesity is still considered a sign of wealth, and I have seen close up what unhealthy eating habits can do to a person.) And of course, if these people who have gained weight were to be inactive, their bodies would eventually lose the ability to cope with the weight they have to carry around, resulting in joint injuries etc.
Having said this… thin people can have diabetes as well. My brother-in-law has got diabetes. And people with really poorly stabilized diabetes often lose weight rather fast because their bodies lose the ability to transform sugar, and instead it runs through their blood and causes all kinds of health problems (kidney, eyes, skin, nerves, … ). People who watch their calorie intake and not the *real* nutritional value of the food they eat are likely to get vitamin deficiencies, osteoporosis, hormonal imbalance – of course they are. And in these cases they should have to adjust their living habits before undergoing expensive and most often not-too-healthy medical treatment.
Yes, I think the first treatment option for fat *and* thin people who have, let’s say, severe acne should be re-evaluation of their eating habits and use of toiletries, to see if that is what is causing their problems, before prescribing problematic ointment for the thin person’s skin and telling the obese person to “drop that weight before you receive real medical attention”.
In the end it comes down to the fact that life is a killer – we die from the accumulation of all the stress put on our system, and our failing ability to cope with the problems caused by life.
Awesome post. Thank you.
I love the clarity of the logic, particularly. It worries me deeply that doctors, generally, wouldn’t see your point. With all their education and training. I guess it’s a sign of how much bigotry blinds some people.
I am so thankful I found a doctor who told me, “Eat well, eat healthfully. Eat the way you know we all should. Get some activity in every day. If you lose weight, whatever.” He doesn’t focus on weight loss as much as health gain.
The sad thing is I would be incredibly wary of such an attitude… which tells me that the culture of pushing thin at all costs has not only damaged people’s bodies, but also their psyches — some of us no longer trust doctors NOT to be pushing a weight loss agenda.
My last doctor was like that too, until he eventually ran out of things to treat me for… and all of a sudden my numbers which while not great weren’t terrible either and had been something “we only need to worry about if they get worse” suddenly became things “we” needed to work on. I had to start walking, at least an hour more a day. And maintain a strict 1200 calorie a day diet and it went without saying that I had to stop eating junk food and fast food entirely. In fact, it would be best if I lived a vegan or at least vegetarian lifestyle no less than 6 days a week. We HAD to get that weight off! And we might have to start thinking about the lap band.
Just find it really interesting how he was all unconcerned about my numbers, and since it was stable obviously my diet and exercise were in balance with each other… until suddenly there was nothing else to keep me coming in every month. Dunno what I would have done had my husband not lost his job (and with it, the insurance) — probably would have fired him, or simply stopped going until something else broke and then gone to a new doctor.
You never said what you came in for every month…what in the world would lap band be good for?
i finally FINALLY found a doctor that is willing to forgo the weight loss treatment plan. i told him coming in that i was bulimic….so he said well are you eating ok now? i said i was, he said good. and then wrote down i i gerd. my numbers came back great. infact my bp was the lowest it has EVER been at the docotrs…imagine that i wasnt fighting with him about OMG OBESITY and my bp wasnt 140/90 it was like 112/75. then we moved on to address my allergies and asthma. easy peasy. i guess this is what the rest of the world does when they go to the doctor? not leave crying in shame with a wls clinic pamphlet shoved into your purse (i dont read the things i just burn them bwhahaha)
I have found its easy to tell how fat friendly they are by looking at the waiting room. what are the magazines? are they all healthy living and diabetes mags? or is it like nat geo and popular science? are there seats to accomidate the supersized? chairs with no arms or couches?
As usual great post ty!
Those doctors are out there – it can be frustrating, but KEEP TRYING to find one. And let your current doctors know why you left. If it’s too uncomfortable to have the conversation in person, send a letter to the office.
I think my doctor actually discovered HAES a little bit ahead of me. Once upon a time she would ‘help’ me with diets, but these days she says outright “I don’t believe in diets – I believe in exercise.” That wasn’t even with any prompting from me. People can learn, and doctors are people; we’ll get there!
life is basically fatal.
For me, 300+ lbs is less healthy than under 300 lbs. I know this because I was coerced into losing 37 lbs to get under 300 so as to “qualify” for a hip replacement. My A1C was normal–for a non-diabetic. My blood pressure went down enough to reduce one of my meds by 1/3. (family history, diagnosed as a teen & a couple of hundred lbs ago, this will never go away entirely.) Breathing was easier. I was more energetic, but I attribute that to the EPO they were giving me for chronic anemia pre-surgery.
HOWEVER, maintaining that weight is an entirely different matter. Without the “stick” of potentially having the doc refusing surgery to relieve massive amounts of pain, I can’t focus 24/7 on what goes in my mouth. It’s exhausting. I have other things I need to do. There’s a cost/benefit here that has to be respected.
So, I’m working on balance. I binged on sweets after months of deprivation. I think I’m about over that now–it doesn’t make me feel good. I have 1 hip that works great & the other is OK enough to move more than I used to, so working on flexibility and endurance. I’m thrilled with the improvement in quality of life. Anyone who isn’t happy with me can please just keep it to themselves!
Your blog was just recommended to me and I am so very glad that I found it. Thank you for being so candid. Body size is NOT diagnosis. I wholeheartedly agree with this and think this message is one we are sorrily lacking in society. Thank you for being a voice.
I just had gallbladder surgery Monday. Now, I knew that it was a possibility for years and not due to my weight. When I had had some issues with a kidney stone, an ultrasound was done and a gallstone was found. It was a large one but it definitely let me know that the possibility was there that I may have issues in the future. Both of my parents had their gallbladder removed while they were in their early 40’s. My older sister had her removed at 22. I’m not quite 31 so in between. Of course, according to my husband’s friend, my gallbladder issue is only due to my weight and is only the start of multiple health issues I’m going to have because OMGI’MSOFAT! He sent a message to my husband on Skype saying he doesn’t understand how anyone can eat themselves to illness and possibly even death and before that talked about how great it was my daughter was learning to ride a bike on her own as it shows that she might not have the issues with eating and being inactive as her mother does (never mind that that didn’t start until I was in high school after I had been put on antidepressants).
Like I said. I wish I had your self esteem. All I want to do is crawl into a hole and die.
Thank you so much for this! Love you and your message, Ragen. I shared this on my FB page, which happens to be seen by several friends who have felt entitled to speak about the fact that they think I should lose weight for my health.