Every time someone dares to suggest that society should stop trying to shame fat people “for our own good” in the hopes they we will all hate ourselves healthy, someone has to wring their hands and say “we don’t want to be irresponsible and say that obesity isn’t a problem”. The truth is that it is absolutely irresponsible to say that obesity is a problem.
When people talk about the Obesity Epidemic or the Obesity Problem, what they are trying to do is make body size a proxy for health, and then make health a societal obligation and barometer for measuring worth and that’s wrong on both counts. Body sizes aren’t really a problem. A label of obesity is the end result of a BMI calculation and it’s ridiculous to suggest that my weight in pounds times 703 divided by my height in inches squared constitutes any kind of health diagnosis, or that my health is anyone else’s business. We’re also taller than we’ve ever been but nobody wants to scream about the Tallness Epidemic or how they have the hot new thing to make everyone shorter. (And isn’t it interesting that we’re okay with bodies coming in different heights, but not in different widths?)
Body size is not a diagnosis and we need to stop acting as if we can look and someone and tell what they eat, what activity they do and how healthy they are, or that how healthy they are is anyone’s business. It also does a disservice to those who are interested in health – it tells fat people that healthy habits don’t matter unless those habits make us thin, and it tells thin people that they are healthy just because of their size. Both of those statements are dead wrong. This hits home even more when we realize how much this issue has been exaggerated – for example the CDC originally told the media that 400,000 deaths a year were caused by obesity – when they were pressed they admitted that the number was actually less than 30,000 deaths but they purposefully chose not to disclose their error or the correct number to the media or change their approach of trying to convince people to get thin as a way to prevent 370,000 deaths a year that they know are non-existent.
It surprises a lot of people to find out that the diseases that are very often linked to fatness have never ever been shown to be caused by fatness – only correlated. And those diseases are also correlated with being under long-term stress. It makes sense if you think about it – if obesity was really the cause of medical problems then we would expect that most obese people would have those medical problems and very few thin people would. But that’s not the way it works. There are healthy fat people and unhealthy thin people. There are people of every size with the medical conditions that get erroneously blamed on body size. If thin people get a disease then it stands to reason that being thin is neither a sure preventative nor a sure cure. If thin people who have these diseases are given treatments that do not include weight loss, why are those interventions not given to fat people?
There is definitely a problem (several actually), but it’s not obesity.
Stigma is a problem.
According to research from Dr. Peter Muennig, a health professor from Columbia:
“Women who say they feel they are too heavy suffer more mental and physical illness than women who say they feel fine about their size — no matter what they weigh.”
When you say that body size is the problem then you are telling people to have a problem with their bodies – betting that they will somehow hate themselves healthy. Knowing what Dr. Muennig’s research found, and knowing that we live in a world where people spend their time making sure that we get a ceaseless stream of body hatred, it would make more sense if people of size did suffer more mental and physical illness. But if that’s the case then the issue is not obesity, it’s social stigma, and weight loss is not the cure for social stigma. Ending social stigma is the cure for social stigma.
Speaking of stigma, Dr. Muennig also tells us:
“Stigma and prejudice are intensely stressful. Over time, such chronic stress can lead to high blood pressure and diabetes.”
Like the stress of being constantly stigmatized by everyone from jerks on the internet to doctors perhaps? How about we give ending social stigma around body size a try? Couldn’t hurt, would probably help.
Making individual health the public’s business is a problem
Someone’s health, their prioritization of their health, and the path they choose to reach any health goals that they may choose are intensely personal and not a matter for public consumption. Health is not entirely within our control. Health is not a barometer for worthiness, it is not a societal obligation, it is not anybody’s business. Public health should be about providing health options to the public, not about making the individual’s health the public’s business.
Access is a problem
We’re spending so much time buying and selling thin, that we’ve forgotten about actual health. Sixty billion dollars went to the diet industry last year. How many local, sustainable farms could we have supported? How many community health centers could we have built. How many food deserts could we have eliminated? Instead we gave sixty billion dollars to an industry with a less than 5% success rate that has been sued repeatedly by the US Trade Commission for deceptive trade practices and LOST EVERY TIME. We thought that was the best use of our sixty billion dollars to improve our health? Seriously?
Studies show us over and over that healthy habits, not weight, are the best predictor of future health. Health is multi-dimensional and not entirely within our control – it includes genetics, access, stress, past behaviors and current behaviors, and health is never guaranteed. Everybody is going to die and if you don’t get hit by a bus it’s pretty likely that things will go wrong with your body, and there is no magical weight that will stop that from happening.
Focusing on body size misleads people about health habits. It also gets in the way of the proper treatment of actual health issues in people of all sizes. Doctors neglect to do basic diagnostic tests on thin people because they assume that they are healthy, and people of size aren’t properly diagnosed because doctors are too busy giving a diagnosis of fat and a treatment protocol of weight loss. We can do better than this. There is nothing to be achieved by a war on obese people that couldn’t be achieved by an initiative for providing access to healthy foods, enjoyable movement options and affordable evidence-based healthcare to those who want them.
Calling obesity the problem is the problem.
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Normally I get between 100 and 200 e-mails a day. During the holiday season that climbs to 200-300 from people asking about everything from how to set resolutions that aren’t about weight loss to how to deal with the family food police. I’ve put together a group of speakers to give you information to support you through the holiday season. Details are here, registration is name your own price.
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32 thoughts on “Calling Obesity a Problem is the Problem”
I definitely vote for better food access, more affordable clinics, and better diagnostic practices over more shaming, more sloppy medicine, and more assumptions about what I eat because of my waistline.
Somehow it seems so logical.
But we wouldn’t want that, would we?
Oh dear. I seem to have spilled a great deal of sarcasm on your carpet just then. Sorry. We’ll wipe that up and ignore everything after the first paragraph, m’kay?
I love your posts, Twistie. Your flavor of sarcasm is right up my ally and makes me smile every single time!
alley… geesh, can’t spell!
Aww, you guys! Thanks ever so.
Right up my ally…. actually, that’s very appropriate here! 😉
Could you recommend a source for the change in the NIH mortaility estimate? The last I looked, I couldn’t find much.
I wish we were okay with people being of different heights– we haven’t made it into a gigantic public menace, but short men get flack for it. I got hassled for being short when I was a kid, but I gather that tall women have it worse.
So well crafted and said! I always love how you write but this one seems to hit on some important points for me today. I’m tempted to post a link on FB for friends and family because many of them would benfit from striving for health rather than weight loss but I haven’t come out of the HAES closet yet. Is that weird?
When someone says something to me, I respond with these points and they have actually been really good about listening and accepting the logic but I kind of dread presenting them with the whole argument even though I think they need to know this. I just get so sick of being told I’m “too sensitive” about things.
Good ‘ole waspy tradition…it is in bad taste to react to anything.
Thank you for todays post.
I am 36 weeks pregnant and attending a birth and breastfeeding class last night. One of the top reasons that was consistently pointed to as to why BFing is “the best” is because it prevents childhood obesity. We got a 10 minute lecture about how if more mothers in the past years/decades BFed we would have less obesity and if more mothers did the better thing for their children, ie: BF, childhood obesity could be stomped out. It amazed me how much “weight” was given to obesity prevention and telling false-truths, the same false-truths that have no real, crediable science to back them up, in of all things a breastfeeding class. Why to go on scaring more people into doing something for the sheer sake of sparing their children the horrid “fat” lifestyle. It’s bad enough adults have to deal with this kind of stupidity on a daily basis, but now we have to share that with our infants. We as a class were even told about how they use to seperate forms of health measures, one for BF babies and one for formula babies bc “formula babies tend to weigh more and are at a higher risk of being overweight because they consume more forumla than their bodies need”. This I think, is why some parents and even doctors are putting infants on diets. And yes, That has been in the news recently. It’s a sad, sick world when we are calling our infants, tiny babies or precious perfection, “fat, obese, overweight” and forcing them to be on restrictive caloric intakes.
When I had babies (mid nineties) my pediatrician told me that breast fed and formula fed babies put on weight at different rates. He had different chart for each, but he pointed out that the babies ended up putting on the same amount of weight, regardless of what they were fed. I find it weird, and disturbing,that the thought process on this has changed so radically.
Surely that’s almost always what happens with medicine though?
As opinions change (I’m not going to call them facts or truths, because that’s not a flexible enough term), so does medical advice.
Within this system there’s also a truckload of mis-truth and commercial/political influence, which only serves to muddy the waters fully. It’s where the internet is also both valuable and highly dangerous.
I’ve also no idead how we’d change this system! Only that if we were all taught how to trust ourselves, make good decisions and learn to feel good, then we’d have much better grounds for taking, or leaving, advice.
I am appalled that doctors put infants on diets. I am appalled that discussions of childhood obesity is brought up in a breast feeding class.
Is the risk of obesity really that much worse than the risk of whatever developmental issues might arise from an infant not getting enough nutrition? Jeez. (Plus, like women don’t get stressed enough over breastfeeding. Some women end up just not being able to do it, for whatever reason. So now they’re going to feel even worse?)
I was born in the early 80s and I’m one of the “lucky” ones that was breastfed 99.99% of the time, and yet somehow managed to be fat all my life. It’s anecdata, but if breastfeeding prevents obesity, I shouldn’t be here.
This made me laugh in a wry way. It’s like we need special health reasons do something loving like breast feeding. I think it’s a matter of love, not physiology. For me, I’d have felt like I lost one of the essential experiences that made me human if I didn’t bf. But that’s a personal decision and others may feel different. It’s not like moms who feed formula are any less dedicated to their kids.
OTOH I’d be skeptical of the chart showing that babies put on the same weight at different rates. It seems too much like a formula company justifying itself. As long as the formula works, who cares?
I think fat shaming is a product of medicine’s inability to find solutions for bona fide metabolic diseases like PCOS and diabetes type 2. They’d love it if we would just shame ourselves into silence so they can look like heroes. But shame is not a medication or medical procedure.
Lovely piece today. If only we could get the health care field to actually work on health rather than dropping numbers on a scale, but then that would take money out of the diet scam businesses.
I have a quick question that probably won’t result in a quick answer. In light of the topic today, does anyone have any previous experience in dealing with schools and pediatricians that force (“require”) children to be weighed and measured for BMI “testing”? I really could use some links and guidance with that.
Fantastic article as always, Ragen!
I know that waaaaaay back in the 1980s, my mom fought like hell to get me excluded from the public weigh-ins that were standard at our elementary school. I think in the case of schools, it should be pretty straightforward–a call or note to the school saying that you do not consent to having your child screened for BMI should suffice. I would imagine the pediatrician would be difficult. There are legitimate reasons for doctors to know what a child weighs. Perhaps asking them not to take that next “step” of correlating it with BMI? I have forbidden my kids’ pediatrician from talking to them about their BMI because I know BMI (especially in children) is a total crock. We talk about BEHAVIORS with them, and the doctors seem OK with that.
Thanks Nichole. I know pediatricians require weight for immunizations (to get the right dose) or for proper dosage for medicines, but I figure any other time a weight really shouldn’t be required for healthy well check visits. The issue I run into is more they “need” it for government stats. My daughter goes to public school heavily funded by government grants so it’s a mandate they get weighed and measured. Actually just got paper work a few hours after writing that from her family advocate about her BMI. I did discuss it with her that I was not comfortable with discussing BMI and why I felt it was not an accurate portrayal of her health.
I guess I’ll definitely gear up with how to discuss with her doctor of talking about healthy behaviors instead of BMI this next wellness visit. Thanks for the suggestion!
This is a wonderful piece of writing. I’ve been reading your blog for a while now and it is continually illuminating. This piece though, seems to lay out the arguments against size-ism so clearly – thanks!
Here’s what I’ve found poking around a bit.
This is the JAMA article with the 400k number the CDC references originally:
Click to access 1238.pdf
Here is a media relations update from the CDC reducing the number to 112,000 (plus PDF file):
And my head hurts from reading so much associated, referenced, indexed, etc. data. But it’s really interesting to see where they get their info, etc.
Oh, and a bit off track, I found this while poking around. The last 2 sentences of the opening paragraph on the National Health and Nutrition Examination Survey page (it was their survey data that was used for the JAMA publication that listed the original 400K deaths attributable to poor diet and physical inactivity).
“….This survey teaches us about the health and diet of people in the United States. Over the years, this survey has led to improvements in the food we eat and the health care we receive.”
I’m not quite sure what to think of that statement…
This post is why I love this blog!!!! Straight-forward and connected to real research.
However, I am running into a problem with my ability to promote HAES. I’m fat. I’m tall. I’m 52. I’ve failed at a minimum of 10 different diets over 35 years and multiple attempts at the same diets. I have stress in buckets in my life and have developed many health issues that keep me from being my best on a day to day basis… nearly all of them are coorelated to obesity. No one seems to take me seriously. I’m the fat, unhealthy woman telling you not to punish yourself dieting. I’m a walking, talking mixed message.
How about approaching it from this perspective:
“Health factors in mental and physical health. I’ve tried multiple diets and they all failed to make me thinner for very long. I refuse to continue focusing my entire life around food and how much of it I can’t have when I’ve already wasted more than half my life doing that. I choose to achieve what measures of health I can manage given my current state without hating my body for the shape it is.”
Feel free to repeat or take inspiration from the above, if I’ve come at all close.
(On a side note, I just noticed you can resize the comment box. Woot!)
Great article with lots of good info! It does not occur to people that a person who is overweight Really doesn’t need it Pointed out to them. One thing I’ve learned, is a healthy attitude toward Every body type is the only way toward being healthy for everyone.
It puzzles me, you see on every t.v show, magazine articles etc etc. about how to be healthy: exercising, eating healthy…..yet, you hardly see anything that has to do with mental health. On shows sometimes you see how the person say ” well i want to feel good about myself” ” I want to be more confident”… and what ‘s their answer to them? loose weight!!! Yes losing weight might help you feel good but, sometimes even if you become a size 2 or 0 you still feel the same, then what?
Nice blog. I am new to your site and I can’t wait to read more. I had to SHARE this on my Curvy Girl Lingerie page on Fbook. I can’t wait to share more of your stuff with my fans. Very fascinating and illuminating. Your writing style makes very complex ideas super easy to comprehend. Thanks so much and get down with your bad ass self!
Wow, thank you so much both for your compliments about my writing and for sharing it on your page (which looks super awesome by the way).
One of your best pieces, imnsho, Ragen! Bookmarked for sharing 🙂
Ooh, ooh, ooh! With your permission I’m going to use the paragraph about how many food deserts could be eliminated and community centers built with the money spent on the diet industry. I am a nutrition educator with a large university and serve limited resource families.
This post is made of win.