Weight, Health, and a Crowbar

I heard something today that I can barely even comprehend.  Reader Lisa told me that her husband went to the doctor because he had been exposed to the potentially fatal Hantavirus at work and was starting to show symptoms.  As the doctor started the exam, he patted her husband’s stomach and called it a “grocery tumor”.

This is egregious, it’s unbelievable, it activates my face punch reflex, and it’s also exactly what we can expect when we constantly and consistently conflate weight and health as we do in our society.

We have convinced our society that we can take a ratio of someone’s weight and height (BMI), or hell – just look at them fully clothed – and make determinations about their health, their cost to society, their habits, their worthiness, their morality and any number of things that helpful people on the internet love to tell fat people about us.

It’s absolutely wrong for several reasons:

Body Mass Index (BMI):  You may have heard that it’s not a good measure of health.  That’s not true.  The truth is that it’s not a measure of health at all – it’s a simple ratio of weight and height. If you know someone’s BMI then you know…wait for it…the ratio of someone’s weight and height.  It doesn’t tell you anything about body composition, habits, or actual health measurements. Body size, regardless of how it’s measured, can tell you a maximum of two things:  1.  What size someone’s body size is and 2.  What your prejudices about that body size are.

It also doesn’t make sense from an evidence perspective – there is not a single study where the majority of participants have moved from “overweight” and “obese” to “normal” weight, maintained it for five years and seen health benefits.  The idea that weight loss is possible for most people is completely unproven – and disproven by the evidence that does exist –  and the idea that if that weight loss happened it would make people healthier is also no more than a guess.  Meanwhile, plenty of evidence shows us that habits are a much better determinant of health than is body size.

And it leads to some horrible things. Like doctors diagnosing fat people as fat and prescribing weight loss while ignoring any actual symptoms they are having and giving them an entirely different treatment protocol than they would give a thin person with the same ailment. Or a so-called medical professional calling someone’s stomach a grocery tumor.  Or people making a full-time hobby out of going on the internet blaming fat people for everything that they can think of.  And on and on until we have a society that is so rife with size stigma and bullying that fat people spend all of their time trying to hate themselves thin and thin people spend their time trying to hate themselves not fat,  while our lives fly by and our bodies go completely unappreciated for what they do, as we risk our health for thinness instead of caring for our bodies and letting them settle into the same beautiful diversity of sizes that we see all throughout nature.

The saddest thing is that we could end all of this tomorrow with one simple step.  We have to take a crowbar and separate weight and health permanently.   Take weight out of the health discussion completely.  Give people of all sizes the same treatment protocol for the same health issues.  Immediately cease any and all health messaging that could create shame, poor body image, or stigma.  End all messaging that seeks to make people feel guilty for their choices or bad about their bodies.  Start giving people information and true access – to the foods they want to eat, safe movement options they enjoy, and affordable healthcare.

We need to be clear that health is a very personal thing and that people get to prioritize their health and choose their path, and that the job of public health promotion is to give people information and options and then allow them to make their own choices without shame or stigma.  Just look around and you’ll see the result of conflating weight and health –   unhealthy relationships with food and exercise, people who think that their bodies are unworthy and therefore unworthy of being cared for,  eating disorders, people trying to hate themselves healthy and failing everyday.  Newsflash:  It’s.  Not.  Working.  We must now perform the most noble act of science: admit that we’ve been very wrong and declare that we’re going to move ahead on a different path.  We are never too far down the wrong road to turn back and the sooner the better.

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The regular e-mail blog subscription (available at the top right hand side of this page) is always completely free. If you’re curious or uncomfortable about any of this, you might want to check out this post.  Thanks for reading! ~Ragen

11 thoughts on “Weight, Health, and a Crowbar

  1. Without detracting anything from your excellent post, I do want to be a public health geek for a moment and refine one point.

    You write, “the job of public health promotion is to give people information and options and then allow them to make their own choices without shame or stigma.” And yes, in general, stigma is very, very bad for health. There are some cases, however, where bad BEHAVIOR (not bad bodies or bad people because there is no such thing) at the population level has been useful influenced for overall benefit by creating social stigma. Examples: Drunk driving — extremely high risk of harming or killing other people; let’s go ahead and say that’s bad and actively discourage it. Smoking in public? Harms other people. I’m also ok saying that’s bad to do.

    It’s a very fine and subtle edge — calling out harmful-to-others behavior without devaluing people. We still need treatment programs for alcoholics, and smoking cessation programs, and we still need to understand how the overall burden of substance abuse falls disproportionately on already marginalized populations and work like hell to eradicate health disparities.

    And, if you come to my house and get shitfaced, I WILL take your car keys and/or disable your vehicle. And if you light up a cigarette, I WILL send you outside.And for that matter, if you want to have sex and don’t want to use latex, I will also kick you out of my bed.

    And, come to think of it, if you disrespect another guest of fine for being fat, I will tell you to STFU and probably not invite you back. So perhaps what we need to stigmatize — again, the behavior and not the people who engage in it — is failure to attend to scientific evidence, and blaming and shaming when nobody is being harmed.

    It’s a fine edge, and sometimes double-sided, but nobody said this stuff was easy.

  2. I should get a T-shirt with that graphic made and wear it to my next appointment with my dear endocrinologist.

    The grocery tumor was probably that doctor’s idea of a cute, humorous segue into discussing the man’s weight. Blah. Or maybe there IS a face punch reflex and this is the test for it. I can see it now: “Sorry about your nose,Doc, but my reflexes are fine!” 🙂

  3. Just a point of interest in response to Kristin Dunkle, I can’t speak for the situation in the US, if that is where you are, but in the UK, the stigma associated with the behaviours you mention – drunk driving and smoking, did not spontaneously emerge into the public consciousness. Rather, they followed legislation.

    Those laws were brought into effect based on strong scientific evidence, and each and every one of them was fought tooth and nail by the general public and consumer groups. They were seen as infringements on individuals’ rights to behave as they chose and government meddling with individuals’ autonomy over their own bodies.

    The change in public perception of these behaviours followed the legislation, not the other way around, once the status quo had been shifted.

    As you point out, the way that we treat out own bodies, whether we choose to exercise or not, eat wholesome food or packaged junk, smoke in the privacy of our own homes, harms nobody but ourselves.

    On the other hand, while the stigmatising of ‘fat’ by our health agencies, even if nominally not encompassing ‘fat people’, nevertheless does exactly that. And the existence of weight stigma amongst medical professionals is well documented. Further, this stigma, and the inappropriate treatment accorded to those patients, does create harm. As does stigma amongst the general public.

    Perhaps the behaviour that should be stigmatised is the bullying of individuals based on how they look, or for any other damn reason. And if the protection of the rights and autonomy of fat people requires legislation, then so be it. This was the case with other stigmatised groups in the past – it is now illegal to discriminate based on age, religion, sexual preference, or race. Do these things still occur? Of course they do. But they are no longer deemed appropriate by the majority or by the law, again, shifting the environment. For the most part, such moves have been unpopular with the general public, or at least the most vocal aspect of it, but strong central government did what was right, because it was the right thing to do. And they changed the world we live in. It is possible.

    1. “Perhaps the behaviour that should be stigmatised is the bullying of individuals based on how they look, or for any other damn reason. And if the protection of the rights and autonomy of fat people requires legislation, then so be it.”

      Yes! Exactly.

      A point on the history though — legislation was not enacted until there was enough public support to get it through. These things are interactive and iterative cycles — both social campaigns and policy change are (I believe) needed, as well as one on one heart to hearts with families and friends.

      If you follow the Social Ecological model, meaningful change happens on multiple levels (there is some canon on this, but I like to think about individual, interpersonal, community, and government/policy at a minimum). Intervening on all levels and in different social sectors (health care, education, legal/policy etc) is needed for real change — which is part of why there is no one “right” strategy for social change — but a great need for everyone to do what they can and what fits for them, and to uphold others who are naturally drawn to play a different but equally important role.

  4. I feel like we should have a PDF of a leaflet prepared for printing and distribution, so people put in this situation by schmucks could just hand them the leaflet and roll their eyes. The leaflet could have text along the lines of ‘Today you behaved like a schmuck because of… ‘ and then various FA and HAES principles, information and resources, and finally something along the lines of ‘And if you don’t educate yourself and stop behaving like a schmuck, you may be subject to legal action, financial consequences, widespread disparagement, and/or Ragen’s Face Punch Reflex.’

  5. I went through seven doctors in several years, with a watermelon sized ovarian tumor undiagnosed because of their nasty flippant ways insisting I ate too much mcdonald’s and lived on my couch and refusal to give me an ultrasound. Finally the eighth listened, dxed me and I was in surgery within a month. All totally untrue, the tumor caused my weight gain by messing with my adrenals among other things. I lost almost all of it.

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