Here are some answers to questions that I often get about Health at Every Size and Size Acceptance. Remember these are just my answers and I can only speak for myself. If you have other questions that you would like me to answer and add to this blog just leave them in the comments and I”ll get on it! (This is a re-post by request. )
Aren’t Size Acceptance and Health at Every Size the same thing?
Nope! Not at all. Size Acceptance is a civil rights movement built around the fact that the rights to life, liberty, and the pursuit of happiness are not size dependent, which is to say that fat people have the right to exist in fat bodies without shame, stigma, bullying or oppression and it doesn\t matter why we are fat, what being fat means or if we could/want to become thin by some means. Health at Every Size is an approach to personal and public health where the focus is put on behavior rather than body size, with the understanding that health is not a obligation, barometer of worthiness, entirely within our control, or guaranteed regardless of behavior. A full explanation is here.
Isn’t being fat unhealthy?
No. Weight and health are two separate things – there are healthy and unhealthy people of all sizes. Health is multi-dimensional, not entirely within our control, and not a barometer of worthiness. The confusion of weight and health does a disservice to fat people because people (often including doctors) think that they can look at us and determine our health, it also does a dangerous disservice to thin people who are told that they are healthy simply because of their weight and that isn’t what the evidence shows. In fact, the evidence shows that people’s habits are a much better determinant of health than their size is. Body size is not a diagnosis. I call this a Galileo issue – “everybody knew” that the sun revolved around the Earth and so Galileo’s statement that the evidence showed that the Earth revolved around the sun was considered heresy. Now “everybody knows” that fat is unhealthy and so statements to the contrary, even though they are fully supported by evidence, are considered heresy. That doesn’t make them any less true. Even if fat was unhealthy, there are plenty of things that people do to prioritize their health that we don’t police (not getting enough sleep, not looking both ways before crossing the street, extreme sports etc.) The idea that public health means making fat people’s health the public’s business is just thinly veiled fat bigotry. Kate Harding has a fantastic post about this as well.
Isn’t Health at Every Size just giving up?
Health at Every Size is a choice to focus on healthy habits as a path to health rather than focusing on manipulating body size as a path to health. Studies on long term dieting show that the vast majority of people regain their weight after 5 years, many regaining more weight than they lost – dieting does not meet the criteria for evidence based healthcare. To me Health at Every Size is about opting out of a social construct, perpetuated by a 60 Billion dollar a year diet industry, that takes our money to solve a problem that nobody has proven is valid with a solution that nobody has proven is effective or even possible for most people. Health at Every Size does involve giving up on some things, including the hope of getting the societal approval that comes with being thin. But the cure for social stigma isn’t weight loss, the cure for social stigma is ending social stigma. Health is a very personal thing – each person gets to choose how highly they want to prioritize their health and the path that they take to get there, and there are no guarantees. For me it’s about the best I can do with the amazing and unique body I have which just happens to be a fat body.
How is it fair that my tax dollars pay for the healthcare of fat people?
Tax dollars pay for all kinds of things and unless someone has a list of everything that their tax dollars pay for broken down by what they do and do not want to pay for, then this is just about prejudice against fat people. Even if you believe that fat people cost more, this is a very slippery slope – should those of us who don’t drink get to opt out of our tax dollars paying for any alcohol-related health problems? Should vegans get to opt out of their tax dollars paying for the healthcare of non-vegans? Should people who choose the Atkins diet get to opt out of their tax dollars paying for health problems of people who don’t eat low carb? This whole argument collapes under even a bit of scrutiny. Also, just to bring some facts to the table, the Congressional Budget Office, and anyone who has actually looked at the number,s has concluded that fat people are barely a blip on the healthcare cost radar.
How can you say it’s ok to be fat?
Because nobody needs anyone else’s permission or approval to live in, and be happy with, their body. Fat people have the right to life, liberty and the pursuit of happiness and that includes the right to live life in the bodies we have without our government waging war on us or having other people tell us that we need to do what they think we should do in the hopes that we will look the way they think we should look. It is absolutely, positively, completely ok to be fat.
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Dances With Fat 
Ragen – I love your self-love. I still struggle with truly accepting my body fat. I want to, but I haven’t yet broken the conditioning of so many years of being told my fat is ugly. Do you have suggestions for those of us who have accepted diets don’t work, and who want to embrace HAES, but are still fighting to let go of the idea that our fat bodies are “less than” somehow?
I have so been there and I feel your pain 🙂 I actually blogged about it here https://danceswithfat.wordpress.com/2012/03/27/when-every-body-but-mine-was-beautiful/ If that doesn’t help let me know and we’ll take another shot at it!
~Ragen
That does help… and it is inline with what I’ve been trying to do, particularly the not thinking snarky thoughts about anyone’s physical appearance. I’m a Libertarian, and I’m very much about people having the freedom to make their own choices, whether that be health related, fashion related or whatever.
I had done very well with Intuitive Eating for several years. Then a friend amputated part of her stomach, and lost a lot of weight… and I was told I was “pre-diabetic” and the combo of the two triggered a lot of my old eating disorder behaviors that had been dormant for a long time. I gained weight as a result (gee, shocker) and I’ve been feeling really insecure because of that weight gain. It leads to thoughts of “I don’t need to be thin, but I do want to be under 400 pounds again.” But that’s a slippery slope for me, because while it’s fine to want that, I also know from over 20 years of dieting experience that I will ultimately only wind up fatter if I try to lose weight.
So, I bought HAES and it’s on my Kindle. I read your blog and find you really inspirational, and you’ve made me realize I am angry. I wasted so much of my life trying to be what I am not… trying to fit into tiny boxes with pretty bows. And I wasted so much of it working to start living it (when I was thin). False promises, shame and propaganda make me furious now. Remembering that fury helps keep me from going down the wrong road again.
J, I have recently lost some weight because some medical issues have finally been worked out and that caused some disordered eating patterns to reemerge and have wreaked havoc with my mind.
I hope you find the the HAES book helpful, the right book at the right time can do wonders. I read Ellyn Satter’s Secrets book first and that was the right book at the right time for me and while I also appreciate Dr. Bacon’s book quite a bit, I find myself more reliant on Dr. Satter’s book. (I can’t state the “for me” part of this paragraph enough times.)
I also find it much, much, much easier to find what’s beautiful about other people than myself. I hope that someday that can translate to me, so I keep up the good thoughts about others. If it helps, I guarantee you, if I saw you, I could tell you at least ten physically attractive things about you.
I’m also dealing with a lot of anger. Anger toward my parents who made me diet for years and years and told me I was unlovable and not special due to my weight, and angry at a society who determines the value of people based solely on their weight. What a stupid way to define people. My therapist says I need to let go of the anger, but I’m not sure what do with it and I feel like just letting go lets too many people off the hook.
I’m kind of ramble-y today, I got up way to early for a doctor’s appointment, but I just felt so much in common with you, I had to respond.
Oh, the anger about my family and the damn strict diets… God, I can relate. And you know the stupid part? My grandmother recently whined that maybe my nephew – who turns three this week – will want to take Irish step dance lessons, so at least someone will have. Guess what? I desperately WANTED TO. But they made it contingent upon my losing X number of pounds first. I was an active kid. I hated phys ed, but I loved to swim, roller skate, ride my bike, run around trying to do gymnastics, dance around to music… and they could’ve harnessed any of that. I would’ve loved lessons in dance or gymnastics or skating. But no. It was all about losing weight. And I was given “special” foods. Instead of just being allowed to eat like a normal person.
So my aunt, who was in charge of my diet, will say I was never deprived because she made me diet snacks. I felt like a freak. I couldn’t just eat what everyone else ate because I was too fat. No wonder, at 5’2″ and 95 pounds at the start of 5th grade, I still felt fat. It didn’t help I was a lot taller than everyone else, and therefore weighed more than all but one boy, or that the gym teachers let one of the “popular” girls record our heights and weights, so we all knew what everyone weighed.
I’m angry at those “teachers,” and I’m angry for all the other awkward and/or fat kids who don’t excel or LIKE team sports and get picked last for gym. And I’m angry that we’re still resorting to shame to try to make people – especially kids – fit into a societal idea whose time has long passed us by.
All the things we couldn’t do as children because we were fat. Do you know they now have chubby cheerleaders at my kids’ schools?! No one makes them get off the court or field either!
Have to chime in because the anger theme is really resonating with me, particularly around messages from family about weight being the only measure of worth, and around the weight-loss-contigencies, and the diet foods, etc. I actually am a psychotherapist, and have been to therapy myself, and while I recognize that “letting go of the anger” may be a worthy goal, the anger has also been very mobilizing for me in terms of getting away from the shame. I’d rather be angry and motivated to not put up with crap about my weight from anybody, than the alternative, which for me was feeling ashamed and sad and angry at myself.
I’m really conflicted about my therapist’s advice because I don’t feel ready to let go of the anger and because of the source of the advice. My therapist had WLS surgery years ago long before I was her client and while she never has pushed WLS on me, I’ve recently lost some weight due to medication changes, she is really preoccupied with it. (She’s also going through regain right now which has her really upset. She tries to hide how upset she is, but she’s doing a pretty lousy job of keeping her feeling hidden.) She is definitely not ready to let go of the dream of being thin and when she talks about how much weight I’ll have lost in a year, it really rankles me. I really don’t want to find a new therapist at this point, but I’m not sure I want keep going to her either.
Lori,
I know how frustrating it is to start over with a new therapist. I hate doing it, and to be completely honest, after what went down with my last therapist, I don’t have any intention of returning to therapy again. We’ll see if that changes, but yeah. So I really do understand… but… that being said, your therapist doesn’t sound like she’s in a position to be giving therapy on weight-related issues right now. She might need a leave of absence to sort out her own problems at this point.
I would talk to her about it. Give her the chance to recognize her behavior, and let her know that her preoccupation with your weight loss – which was not intentional on your part – isn’t helpful to you, and might actually be a negative for you. Her behavior could become a trigger for you easily, or at least it sounds that way to me.
If she continues to do it, or her own unhappiness continues to seep into your sessions, then you’ll have to decide if you’re able to get enough benefits from those sessions still to make it worth any of the negatives.
It’s an undesirable situation, for sure. I wish you a lot of luck.
Thanks for writing this. I’d have sworn that Big Fat Blog had a FAQ, but I can’t find it.
I have a suggestion for the list, fast bodies have the right to wear whatever they like. If I’m comfortable letting my back fat show or my cellulite or whatever, that’s not hurting anyone. And that crap about “it’s hurting my eyes” is exactly that, crap.
Constructive and comprehensive. Bravo.
I’m printing this out for my upcoming doctor’s appointment. I’ve gained quite a bit of weight over the past two years and she is concerned. Although she did tell me that if I could walk two miles that would mean more than weight loss.
I thought I was further in my HAES journey, but last week I freaked out when I couldn’t find the scale. I thought–and then said out loud to my husband–“If I don’t know what I weigh, how will I know whether to hate myself or not today?!” Sad thing–I said it as a joke but really meant it. I am a hot mess! lol
Hey Susie,
The journey is absolutely a process, especially since we are absolutely bombarded by diet industry’s propaganda. I think that you are doing awesome 🙂
~Ragen
I’m so glad to have found this. I’ve been trying to articulate my objections to the whole Weight=Health argument, but I get so worked up trying to counter the “BUT SCIENCE” arguments when there really haven’t been all that many studies done trying to refute or further clarify the many, many years of FAT+UNHEALTHY/BAD/WRONG studies out there.
Looking forward to reading more!
This frustrates me to no end, because sizeists refuse to acknowledge we’re at a disadvantage when it comes to research, that we are research outliers. That saying, “Where’s your research to back this up.” is just an intimidation tactic, in knowing it’s not there. They use the claim of needing research as a silencing tool, and if you do provide research, they will quickly dismiss it as biased because a thousand other studies which are biased by the anti-fat or diet industry involvement are not biased according to them. All studies are biased, yet the only ones that get pointed out for that are the ones that say fat isn’t horribly unhealthy.
Hi Ragen,
Quick question here. I’ve been reading your blog for awhile but never commented. I’m a scientist and I was talking to my colleague about HAES and how weight-loss is not evidence based medicine. Do you have a list of links to the actual scientific studies that support this? That way I could send them to her and keep them for future reference.
Thanks!
Brianna
Hi Brianna,
Thanks for asking – I think that you’ll find the answers to that in the evidence list at the end of this post. https://danceswithfat.wordpress.com/2012/04/21/for-fat-patients-and-their-doctors/
If that’s not what you are looking for just let me know.
~Ragen
A colleague of mine told me today that he was denied a cortisone shot in his knee by the VA because of his weight. He was told that when he got down to 250 pounds, then he could have the shot. This seems so wrong to me. He wants to be more active, but cannot because of knee pain. This pain is treatable, and the treatment could enable him to be more active, which would improve his health. But, they will not treat his knee pain because of their pre-conceived notion of what is healthy.
Well that’s just crap, my GP gave me a cortisone shot when I was was at a much higher weight. He’s not keen on giving them more than x number of times a year but he never said there was a weight limit. (Mine was for hip pain).