Public Health is NOT Public Thinness

I gave a talk today to the students at the Texas A&M School of Rural Public Health (They have a great blog that you can check out). They were awesome – attentive, open-minded and they asked excellent questions.  One of my favorite questions was a woman who asked what I thought was the number one most important change that could be made in public health.

My answer was that we need to take weight out of the equation and make public health about public health, not public thinness.  Right now the idea of “eradicating obesity” is a major part of public health effort and I think that every penny we are spending on that is a waste of money. So what would I spend money on? I’m glad that you asked…

Have you heard of “Food Deserts”?  These are areas where there is a lack of affordable fruits, vegetables, whole grains.   You know that money that we’re putting into commercials that talk about how many calories a day breastfeeding burns and how it will stop your kid from being fat?  How about we spend some of that money making sure that moms, and everyone else, have access to affordable healthy foods.

There are people who don’t have safe access to movement options that they enjoy.  Even if they like jogging some people can’t do it safely in their neighborhoods.  Some people would love to swim but they don’t have access to a pool.  Some would love to dance but don’t have access to classes. Remember those horrible fat kid-shaming billboards from Georgia?  What if they used those millions of dollars to build some non-profit community fitness centers and help existing community fitness centers take sliding scale payments.  All the money the Ad Council spends on OMGDeathFatIsComingForYou ads?  Let’s spend that letting people know about those fitness centers and how they are fiercely anti-shame and all about health for people of all sizes.

You know every damn penny that we are spending having a war on fat kids?  How about we re-purpose that money to be for healthy healthy kids of all sizes.  Gym classes with all kinds of options  -the end of dodgeball as we know it – some kids can walk around the track, some can swim, some can dance, some can play computer games that require them to move, whatever will help them create a lasting love of moving their bodies or at last keep them from just hating the crap out of exercise. How about some school lunch offerings that are nourishing, appealing and affordable?

All those grants that we are spending for researchers to keep trying to figure out how to make us all fit the same narrow height/weight proportion?  Let’s re-purpose that money for research to make us healthier.  Let’s train doctors how to work appropriately with people of size – from a place of respect – treating health issues with health interventions. Let’s cure some form of cancer.  Let’s do SOMETHING a little more worthy of our time and money than ignoring the diversity of the human experience and trying to make everyone fit the same very narrow ratio of height and weight.

And it’s not just money.  Every second that we spend talking about the war on obesity, body shaming, body snarking, acting like someone else’s body size is our business, or confusing body size with diagnosis or health… What if we re-purposed that time to doing, oh I don’t know, anything else? I don’t think that people hate themselves healthy, because I don’t think that people take good care of things that they hate.  If we would back the hell off so that people weren’t obsessed with not being fat anymore, or not getting fat, or hating parts of their bodies, then people would have an opportunity to realize how amazing their bodies are, appreciate them and then care for them in their own way without constant stigma or constant threat of stigma.

I think any public health intervention that leads people to hate their bodies is a bad intervention.  I think that making everyone the same size is not the same as making everyone healthy. I do not believe that getting rid of fat people is a goal worthy of any time or money.  I think that giving people access to healthy foods, safe movement options that they enjoy, and love for their bodies are goals worthy of all the time, energy and money that we can possibly spend on them.  I have great hopes for the students of the Texas A&M School for Rural Public Health and for society in general that we will get past the scapegoating and stigmatizing of people of size and get onto the business of giving people access to a variety of options and then respecting their choices.

47 thoughts on “Public Health is NOT Public Thinness

  1. Maybe put some of the money towards telling people not to be public nuisances towards fat people trying to exercise.

    I have a public pool not even a half mile away, well within biking and even walking range from me. I even have a $50 pass, which is if I remember right 10 admissions.

    In three years since I bought it, it has never been used. All because I didn’t even get out of the parking lot the first time before someone started asking where the harpoons are kept and if anyone still had an old whale oil lantern.

    But maybe if rather than instilling a fear/hate of fat people as a substitute for health education in children, and instead taught them healthy habits that are good for EVERYONE… maybe it will go down to being only the real jerks causing grief. Unfortunately, I doubt discrimination will ever go away entirely, seems like humans just really like saying “you’re different, you’re the cause of everything wrong in the world and everyone needs to hate you”.

    1. It’s funny how much the attitude towards fat and fat people is just so ingrained that some people don’t even think about it. Me included. I’ve always been bigger, so if I go swimming I’ve always covered up as much skin as possible, but fat is ugly isn’t it? I wouldn’t have even questioned that before. I have been guilty of judging bigger people who wore skirts that were “too short” (showed their fat) or anything that showed their stomach. Wow! I need an attitude change.
      Thank you for your post, it has made me think.

  2. Yeah I love that–the whole you can win for losing thing. I have experienced the same thing. The getting told in a very hostile way to “get out there and exercise my fat ass and lose some effinf weight.”

    So what happened when I took my fat ass out there to exercise and lose some effing weight? I got all kinds of feedback (some direct, some indirectly-direct read: whispered loudly enough so that I could hear) like “Eeeeew fat people should try to move too much; their fat bouncing is gross”. Or “God, have some decency and keep your disgusting fat body at home!” or my personal favourite from a obviously naturally thin persson to her equally thin friend “I don’t know why they let people like that in here: it’s really distracting for those of us who like to take care of ourselves.”

    And people wonder why the older I get the more “aggraphobic” I become. It’s not that I’m aggraphobic; I’m not scared to go outside. I just can’t be bothered dealing with all the efftards that seem to be reproducing by the gross.

    1. It’s funny how much the attitude towards fat and fat people is just so ingrained that some people don’t even think about it. Me included. I’ve always been bigger, so if I go swimming I’ve always covered up as much skin as possible, but fat is ugly isn’t it? I wouldn’t have even questioned that before. I have been guilty of judging bigger people who wore skirts that were “too short” (showed their fat) or anything that showed their stomach. Wow! I need an attitude change.
      Thank you for your post, it has made me think.

      1. Thanks for reconsidering. I used to have a lot of judgment about other people’s clothes and such. I think sometimes it’s difficult to separate what we would want for ourselves and what’s cool for others (which, from my perspective, is whatever they want…) Now I’m able to see all different shapes and sizes of bodies as beautiful but it took some work on my part 🙂


  3. I just read this post, just as I was feeling what is the point sometimes? Head, bang, wall. People ask me about HAES, I explain, they agree and then the next thing I see is FB updates about diets or detoxs and how much weight they have lost. Then I look at my reading and lectures notes for tomorrows class and obesity still features, well waist girth as an indicator for metabolic syndrome (plus 2 others) yet how many times do I tell them that the originator of the sydrome did not include weight or waist measures as metabolic syndrome is found in people of ALL sizes.
    So now I’m feeling better being reminded that there are many others spreading this message too. Thanks and great points for health promotion persons to take note of.

    1. Don’t be too harsh on those people who agree with you and then post about diets and weight loss. It is really hard to shake the conditioning of a lifetime. I was very excited to find this blog, and I think that so much of it resonates with me. But I still got excited yesterday when I found a dress I loved and found that I needed a size down from before. I DO work towards embracing how I am now and Do really want to be fit more than thin, but it is hard not to sigh at times that I would like to be skinnier. It’s such a habit that it happens automatically, whereas I have to actively make myself think the positive messages. Just keep talking to your friends, I bet they’ll get there one day!

      1. It’s true! I stepped on a scale a couple weeks ago and found I’d gained weight, and I went into PANIC MODE. It took me some hours and many affirmations to relax.

  4. I would like to see an affordable single-payer health care system that is available to ALL Americans, regardless of body size, income level or pre-existing conditions.

  5. Along with your first point about food deserts I’d add that I would like to see better education for people on how to cook nourishing food– not all of us are lucky enough to have been taught what to do with a Brussels sprout or box of quinoa. “Kitchen grants” for buying pots and pans and utensils and updating unusable stoves and refrigerators. And, somehow, a little extra time in the day to cook. It’s no good to have access to better food without these things!

  6. Bravo!!! That was, for me, your best blog I have read so far. It didn’t sound bitter (which I understand might happen when you receive over 300,000 negative signals directed at you every year). I read your blogs quite regularly and they really have opened my eyes. I am not a round bodied person but I teach yoga for round bodies and wanted to understand where round bodied people were coming from and your blog does that. It also has really opened my eyes about acceptance and I thank you for that. A lot of really viable options for gaining health in this blog. Way to Go!

  7. with 2 children who get free lunches at school i am APPALLED at the quality of “food” offered. To the point that my kids TAKE their lunches like 2x a week. (and i am a cheapskate/thrifter/coupon/freebie gal all the way) they get frozen chicken nuggets at least 2x a week. until they put in a garden last year the kids NEVER saw any fresh veg EVER at lunch. now at least there are cucumbers, tomatoes that sort of thing. freaking a bag of fritos and a can of freaking chili is considered a “healthy” entree by the gov’t entity that controls the school lunch program. i mean this weeks options:pizza dippers, flatbread pizza, hamburgers, nuggets, corn dog nuggets, mac n cheese n lil smokies…bleck. not a single ACTUAL food in the bunch. no real cooking…just heat n eat. of course, you can always opt for the smuckers uncrustable for an entree…or yoplait yougurt and teddy grahams. (anyone see a trend here?)

    And so many law require there to be proof of x amounts of fat, y amounts of salt ect. and that is not as provable with say a roast. but frankenfood qualifies…see, its 35% whole grain with less than 5 grams of fat a serving…says so right here on the side of the bag. schools are not being allowed to serve homemade baked good for contamination fears…ugh i could go on and on. Is it any wonder that fatness correlates with income level? besides the food dessert and lack of time to cook issues (thank GOD we squeak by with me being a mostly stay at home mom) We have this level of crap being shoved down their throats at lunch, while making them feel GUILTY for not eating better in health class…and the school, where they are learning this shit, is serving them food i would not feed my DOGS let alone my kids.

    The poor kid, the kids who depend on these free lunch and breakfast programs for 60% of their nutrition in a day, is being forced to eat the EXACT foods that later on in health class the skinny, white privileged teacher will have them lable as bad or unhealthy foods. They are in elementary school. there is no salad bar option. there is eat this burger or go without. eat this sausage patty and slimy egg sandwich for breakfast or starve till your greasy lunch. instead of forcing a steady stream of ahte the unhealthy fatty, lets simply offer them a decent healthy lunch.

    1. OMG this. I qualify for free school lunches, too, but I always send my kids to school with something they or I have made.

    2. yeah, feed them a crappy govt approved lunch and it will still be held as the kids’ fault if they get fat. Government is so good at shooting us all in the foot.

    3. Hearing about this always infuriates me. I believe you 100% — it just doesn’t have to be this way. (And I wish food-orderers and menu-planners would figure this out.) I teach in a district that is 90% free lunch (and breakfast). While breakfast is admittedly something to be desired, However, one of the options *always* available at lunch is salad (with at least some spinach mixed in the greens and various forms of fresh veggie add-ons) with a vegetarian protein source (egg, beans, etc.).

      1. Exactly. My children get reduced-priced lunch, and there is always, and I mean always, a fresh fruit and a vegetable served. This month’s menu included “black beans and quinoa,” which I note because of the above comment about quinoa being a food that those educated in the kitchen might use (besides being healthy). I know some schools have bad food, just like I know food deserts do exist, but when people go all ranty on how awful school food is as if it didn’t vary across the entire nation, it is irritating. And I feel people are looking down on me for letting my kids eat school lunch, when it is an informed choice I’m making and is perfectly healthy at my school, and never suffers from my “off” days where I might just want to throw whatever in a bag because it’s time to go!

    4. I’ll take eating your so called “garbage non-food” any day of the week over what I’m currently living on, which would be ramen noodles, ramen noodles, and oh yes… ramen noodles. Except today we’re living large, because we splurged on a whole box of rice-a-roni to split between two people.

      Pizza rolls, man and cheese, and corn dog nuggets are probably a hell of a lot more nutritionally complete than that.

      I think your attitude would do JUST AS MUCH DAMAGE to those poor kids as the “skinny, white privileged teacher” telling them the same thing you just said. And why does race have to be a part of this at all? I guarantee you there are numerous black families in this country who eat a hell of a lot better than my poor white ass, and make the same asinine judgement values about the worth of the food I can afford and therefore my own value for not “choosing to eat better”. Being privileged and clueless about why people eat the way they do is obviously not restricted to any one race.

      1. i myself am white. so are my children. the school district is in a very privileged, rich area, with only a few kids on the free lunch program. Every single teacher there is a skinny, rich and traditionally gendered/colored/and sexually oriented. it was more a comment on the makeup of the teachers and the disparity between them and their students than a class attack.

        I too have been poor enough to eat ramen. I have had to go to food pantries 3x this year, and sometimes you starve even if you qualify for food stamps. (which we did at the first of the year but since then we got a 10 cent an hour raise…and now we make enough to not get them) but the school lunch program exist to feed children in this situation. it is designed to give kids something BETTER than ramen 3x a day.

        The government is funding school lunches like what i mentioned above AND pushing a anti obesity agenda. It’s just crazy to me. isn’t it their best interest to start at home and MAKE the schools feed the kids according the the very guidelines they are forcing down our throats? or is just easier to blame the poor, overworked parents and blame the fatties?

      2. Ramen noodles are a staple. Even when I can afford other food, I have them in my house. There’s nothing wrong with ramen, and there’s nothing wrong with people who choose to eat anything they want. Health is not a moral obligation.

        However, if schools are going to offer food to children, they should offer nutritious food. Instead of food that’s just a little better than they can afford, why not give them food that’s a lot better than they can afford?

  8. There needs to be a huge paradigm shift — the one you described — where we focus not on fatness but on health. I keep struggling to find the analogy, but if people have gotten fatter, that’s a symptom of the larger neglect of people’s health.
    I’m so glad to hear that the audience was receptive. I hope you have the opportunity to present more!
    I also want to take an online dance class from you!

  9. I think the money spent on advertisements saying that breastfeeding is best should be spent on actually making it easier for women to breastfeed if they want. These ads are just more body shaming. “You should use your body for this, but we know you can’t (for any number of reasons) so shame on you. Oh, you managed to do it? Well, shame on you for using your breast for a non-sexual purpose, you pervert.”

    They don’t do anything about the real issues, like insufficient maternity leave, lack of workplace support, and people in the mall glaring at women trying to feed their babies.

  10. I wish a group of people could get together and challenge someone like Michelle Obama directly in the middle of her war against obese people, teach her about HAES and that the number on the scale matters very little when it comes to measurements of health. I wonder what she would have to say for herself.

  11. I agree with much of this post. However, obesity (not just what is now called overweight, but carrying say, 100 extra pounds) is a health issue. It’s just not the only one.If you are lucky, and still young, in your 30s or 40s, you may well be able to do everything, stay healthy, and carry a lot of extra weight, but in one’s fifties, it does tend to catch up in ways that are hard to deal with.

    But yeah, heavy people should be just as welcome at a pool, a marathon, a dance club, a gym, as anyone else. What we have found useful is to sign up at a local community college for “fitness class” which allows us to use the gym and the equipment most days and hours of the week, for an entire semester for the cost of a one unit class and a parking tag. CHEAP. And many people of all shapes and sizes go there. And ages.

    I was very sad recently when a friend of mine suggested that the sumo wrestler who is running marathons “made a mockery” of those who were “serious” about training to run. I asked her why he shouldn’t be running, and what she suggested he do while he was “attaining the body shape which won’t make a mockery???????” She ahd no real answer.

    Nonetheless, I do think that it is easy to be young, large, and so far without any problems resulting from weight, and very difficult to make it into your fifties with none. So, my only disagreement is this – I do think that an excessive amount of weight is hard on your body, over time. So I see it as part of public health.- and I see many of the things Michelle Obama is suggesting as helpful to ALL kids. Her campaign is Healthy Kids, healthy Bodies – not skinny kids, skinny bodies. She isn’t skinny herself.

    And, I hate that people say stupid things if we go to the gym – don’t be intimidated. Just go up and stare them down.

    1. Hi Katie,

      Thank you for your comment. I agree with a lot of what you said in terms of being for healthy kids and deserving a safe place to work out. I do disagree with you about Michelle Obama – she has couched her campaign as a “war on childhood obesity” including claiming that she is going to “eradicate childhood obesity in a generation”. To me that’s not being for healthy kids, that’s being against obese ones.

      I also think that you are committing a couple of very common errors. First, you are stating your opinions as if they are facts. When you say “obesity is a health issue”, you are stating your opinion, not a proven fact and on this blog we try very hard to make the distinction. Obesity is a ratio of weight and height, it is not a diagnosis. In that same vein is your use of arbitrary numbers “say 100 extra pounds” and “in your 30’s and 40’s” as opposed to “in your 50’s”, again those aren’t substantiated or even specific definitions, they are just vague guesses. My opinion is that bodies come in lots of different shapes and sizes (just like feet, hands, noses etc. do). I know healthy and unhealthy people of every shape and size. We have different opinions and I respect your right to yours, but I do think it’s important that we are clear about the difference between our facts and our opinions.



    2. I would point out that thin people also get health issues as they age. there is no health problem fat people get that thin people don’t also get.

    3. My best friend is 62, weighs 260lbs, and is 5’8″. So definitely obese and definitely carrying more than 100 extra pounds.

      She trains her own dog in agility. This dog has won more agility titles than you can shake a stick at, to the point where the abbreviations for said awards total more letters than in his entire registered name.

      When can I expect her extra 100lbs to catch up to her as she ages? I’m sure she’d love a little warning about that.

      1. Maybe they won’t. And I don’t think your friend is carrying 100 extra pounds, by the way. As I said, I live where people tend to be EXTREMELY overweight.
        And, congratulations on her dog training. Quite an accomplishment. However, it is the dog who is agile. (I also have trained dogs for agility – with less success!)
        Still – you are right, Many do well for a long time. I’ll tell that to one of my best friends, who was also fine into her 60s and is now sporting a prosthesis on the leg she lost to diabetes.
        My point isn’t that EVERYONE who is obese will suffer from it, Just as not everyone who smokes dies from lung cancer or heart disease. Nor do i think anyone should hate their body. What I do wish is that it were possible to discuss the frequent downsides to health of carrying large amounts of extra weight, without people thinking that such a discussion means “HATE YOURSELF” – It should just mean “Eat healthy foods, stay active, have a life, and don’t wait until some day when you are “perfect” in all ways to LIVE”
        Which is, really, what this excellent blog is all about.

  12. Out of one side of their mouths the Government wants us to eat healthy, but serve our kids, our poor, our grandparents, non food. When schools have tried to grow gardens, often it’s shut down, because it competes with those companies that sell the junk to the schools, and give the schools money. Hell two people recently were in the news arrested for having gardens in their yards because they were considered unsightly. Fresh whole foods, organically grown, fresh water and excersize is the key.

  13. Katie, I would like to speak to you as a 62-year-old fat woman. I have disabilities, yes, arthritis, but mostly in my hands & arms, & I was born with cerebral palsy, not related in ANY way to fat. I have & have had many relatives who lived into their 80’s & 90’s while being quite fat. Most research indicates that it is normal & natural for most people to gain some weight with age & that generally fat people do better as they age than the very thin. It also indicates that weight loss becomes more dangerous & harmful as we age, so that by the time you reach my age, it increases your mortality risks by several hundred percent. Also, studies seem to indicate that whatever SMALL (& I DO mean small…when you really investigate & take apart the numbers, the increased ‘health risks’ of fat come out to a 1-3% increase of risk) risks there are with being fat in youth pretty much disappear as we grow old. Actually, if you want to argue anything about weight & age, it looks as if older people do better being fat than younger people do, though most young people obviously do fine.

    Also, plenty of very large, long-term studies have shown that fitness matters, weight does not, & that fat people who exercise regularly are as fit & healthy as thin people who do, & much healthier than thin people who do not. Lastly, I want to point out that, if it is virtually impossible to lose weight permanently while one is young, it becomes even moreso with age. Don’t worry too much about us old folks, let us own our own bodies & decide how we live in them, too.

    Also, Michele Obama sure as hell isn’t fat, or even anything close to plump, &, yes, she does believe ‘healthy’ kids means the same thing as ‘thin’ kids.

    1. By the standards imposed by society, Michelle Obama, who probably outweighs her taller husband, is not THIN. She is a muscular, athletic woman with a nice round butt.

      And, you are right, it is better to go into old age with some extra weight. “Overweight” people being better off than both Obese and Underweight folks.

      I’m glad you are healthy. A friend of mine in his mid-sixties, who has been quite heavy his whole life (I mean, 300 pounds – 400 pounds, all the time) was also quite healthy and active until two years ago when he showed signs of advanced Type II diabetes, and also serious heart disease. So, now he is facing some serious problems. and he is not ready to hang it up.

      I live where there are a majority of people who weigh a lot. Most adults weighing well over 200 pounds. I see a lot of early disease. I hope it is not connected.

      Anyway, PEACE. I think everyone should live their life as they wish. Fat, medium, or thin. And I sure as heck agree that EVERYONE can be healthy.

  14. “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated, but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
    – C.S. Lewis

    Lord save us from the public healthists. We’re too stupid to decide for ourselves to become thin like them, so they’re trying find ways to make us do what they have decided we should do.

  15. I found this blog through a link someone posted on LiveJournal, and I love it so far!

    Along the lines of public health, I definitely agree that things should be changed. Instead of being about “eating/not eating such-and-such in order to be thin”, it should be about “eating/not eating such-and-such in order to be HEALTHY”. Exercising with overall health as the goal. Recognising that mental health, as well as physical health, is also very important (especially since, like you said, people don’t hate themselves healthy). How we exercise and what we eat should be about loving, taking good care of and honoring the bodies we’ve been given, not about hating them and trying to force them to be something they’re not naturally.

    And I feel like much of the “healthy” talk I hear about talks about just focuses on things like calorie count and fat content, and I don’t think that should be the whole scope. I think what’s actually IN the food we eat (chemical-wise, etc) should be a focus, too. Some low-calorie/low-fat stuff, while eating it might help us lose weight, can have so many other extra ingredients (that I can’t even pronounce) that sometimes I wonder if it’s even worth it. We should be getting the artificial hormones out of things like milk and meat (and feed our cows grass instead of grain, etc), and the chemical pesticides off of our fruits and vegetables — and overall, make “organic” products more affordable for people! We put so much chemical crap in our bodies because everything is processed, and I don’t think that can be good for us.

  16. Tonight I’m really admiring the honesty, clarity, and directness of this post and many of the comments I’m reading. One reason why I love the fatosphere and especially this blog community is that people in it are explicitly examining damaging cultural assumptions in the face of overwhelming ignorance and massively-funded dissimulations. This comment set makes me wish there was a “fat power” salute, like the Black Power salute, so I could do it. Maybe it should be grabbing grabbing one’s belly roll and shaking it. Hmmm–but then what would a more inclusive a “size power” salute be for those who don’t have rolls???

    1. Honestly, I think being ‘shamelessly’ fat in public is probably the most effective fat power salute fat people have 😉

      But for thin allies, there’s this secret handshake once you’re inducted into the fatosphere. Palm up, palm down, shimmy to the side, pump a fist, then do a jazz square. Voila! 😉

  17. I work in public health and would like to defend what we do…except I agree, the ongoing philosophy of what is good for population health is driven by some outdated and sometimes just wrong information. To be fair to public health, since our client is supposed to be population based not individually based and since policy makers believe that this is what is wrong with the population, funding is attached to promoting those projects that ‘fight obesity’. Public health employees at the front line are expected to promote this agenda. When I see individuals I don’t push the agenda of my employer but try to treat each individual as the unique person they are. As a fat person myself, it is pretty hard to preach fat hate as I believe in FA. So we may be rare but some of us in public health do talk a different message than the party line.

  18. This was a really awesome post. Many excellent points!

    “My answer was that we need to take weight out of the equation and make public health about public health, not public thinness” – I loved this one! And I also loved, “People don’t hate themselves healthy.”

    I want to steal these lines for when I talk to care providers and medical students and midwifery students. May I use them?

  19. I have battled with a very severe eating disorder for years (I was both anorexic and bulimic) and now I am a bigger lady with curves to die for and I LOVE myself more than I ever have.

    I bought into the whole cult of thin for a very long time and it took finding my husband to realize that you don’t need to be thin to be beautiful, you just need to be yourself and remember to EAT!

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