Both Sides Now

Ask QuestionsI am often struck by a particular issue in public health messaging wherein there are two sides of an issue but we ignore one of them in order to reinforce cultural stereotypes about health and weight.

For example, almost everyone knows someone who eats a ton of food and never gains weight. Although that person may be treated poorly (which isn’t cool at all) we tend to accept that this is a phenomenon that can happen.  Yet if a fat person says that they eat a reasonable amount of food but don’t lose weight everyone starts yelling “THERMODYNAMICS!  YOU ARE A BIG FAT LYING LIAR!”  If we accept that some people eat a lot of stay thin, then we have to accept that some people eat a little and stay fat.  Of course how much someone eats, why they eat it, and what size they are is nobody’s business but the fact that society only accepts one side of this equation is very troubling.

Another dangerous example is the belief that the only way to increase mobility is to lose weight.  We believe that people will move better with less weight and the same amount or less muscle (because muscle may well be lost in the weight loss process,) but we don’t accept that people can move better at the same weight with more muscle.  Considering that the vast majority of people who attempt intentional weight loss end up fatter, this is highly problematic since the most common outcome of the mobility intervention is most likely to have the exact opposite of the intended effect.

Peter Muennig’s work from Columbia found that “Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms.”  He also found that “The difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health.”

But those of us who suggest that liking and appreciating our bodies is the first step to health (knowing that health is not entirely within our control, not a barometer for worthiness, and not up for public discussion), and that public health interventions that shame and stigmatize fat people may actually harm us, are shouted down by people who insist that shaming and stigmatizing fat people – convincing us to hate ourselves – is not only necessary, but laudable.

Currently our public health interventions are based on shaming and stigmatizing fat people, making fat people’s bodies the public’s business, and equating body size with health.  This isn’t working, largely because shaming and stigmatizing fat people tends to work and so we believe that our bodies are not worthy of care, and because weight and health are two different things.

On the other side are Size Acceptance and Health at Every Size which insist that basic human respect and the rights to life, liberty and the pursuit of happiness are, in fact, inalienable and not size, health, or healthy habit dependent.  They also suggest that liking and appreciating ourselves gives us the best platform for making decisions about health and self-care, and that, if health is a priority for us, healthy habits are our best chance for our healthiest body (though of course there are no guarantees.)  I’ve looked, and lived, at both sides and now and I am so happy that I did.  This side is better by leagues and I’ll never go back.

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If my selling things on the blog makes you uncomfortable, you might want to check out this post.  Thanks for reading! ~Ragen

20 thoughts on “Both Sides Now

  1. The crucial words there are “yelling” and “shouted down”. Nearly all of our political and social problems are caused by those words. Substituting volume for logic and listening simply causes everyone involved to shut down.

    1. That’s what they hope for. They don’t care about being right as much as they care about just shutting us up.

  2. I can’t imagine going back to my life before HAES. I feel awesome and am in the absolute best physical shape of my life (and still fat!) 🙂

  3. Ragen, this post is excellent. I’m a medical student, and constantly bombarded with fat-bias, fat shaming, and pseudo-scientific explanations for why. It’s not even a question — if our answers aren’t “Fat = bad”, then we’re wrong. There’s no discussion about the lack of correlation between weight and health, or even a discussion on a definition of health. While I understand that medical education is geared towards passing standardized board exams, I cringe both inwardly and externally every time blatant fat bias is trumpeted as health education. I would love if you’d produce a book or pamphlet geared towards medical professionals — logic and medical proof basically pointing out how their current mindset is anything but scientific or sound. You do a great thing.

    1. I’m with you on this one Whitney! I graduated in 2008 with a Bachelor of Science in Dietetics. While there were a few professors who discussed studies supporting HAES, the vast majority were very weight bias and also into the “good food/bad food” dichotomy. Just goes to show how far our culture reaches with respect to weight bias and bigotry. The very people who are supposed to be helping educate the masses, are actually hindering the health of the nation by buying into this fat=bad mindset. Not to mention the fact that I had fellow dietetics students go on cleansing fasts and had their own personal issues with weight and food.

      1. There is a dearth of critical thinking in this country. We’re taught to parrot the party line and punish those who don’t bow their knees to our superior “knowledge.”

  4. Hey Ragen,
    Your posts are so great. Thanks for this.
    I have a question. I have a friend who is doing some kind of “medically supervised” diet encouraged by her naturopath. I told her about HAES. She says that she really likes HAES but she and her naturopath are focusing on weight loss at the moment because “extra weight” supposedly exponentially increases her risk for cancer relapse. She’s had cancer twice and went into remission fairly recently.
    I am really skeptical about any connection between what is supposedly “extra” weight and cancer relapse. Do you have any thoughts, statistics, etc about this? Please respond — inquiring minds want to know!

  5. I have a friend who is doing this “Cohen’s Lifestyle Diet” thingy … apparently it’s all chemically balanced and tailored to your bloodwork etc. She’s not allowed to eat many fruits and vegetables but get this … diet coke is fine!
    What the actual f**k??
    HAES is the way to go Ragen you make so much sense I love it!

  6. I don’t know where I read this – maybe it was here, maybe not – but I read, when a person pulls out the “laws of thermodynamics” you should say “Ok, please quote me the 4 laws and explain them. Then explain to me how the human body is a perfect system for thermodynamics.” (hint: it isn’t.)


  7. I personally know two “lucky” women who could “eat whatever they wanted and still stay thin.” One of them, my sister, also got sicker than anybody else during flu season, etc., because she had no fat reserves, and the amount she had to eat simply to stay healthy led her classmates to accuse her of hiding bulimia. (Her metabolism changed in adulthood, thankfully.) The other, a former co-worker, turned out to have the worst case of endometriosis her surgical team had ever seen and it may well have been the illness that was devouring all of her calorie intake. She was also cold all the time.

    But, you know, SO lucky.

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