Fat and Unhealthy

fight backI got a question from a blog reader who asked:

You speak a lot about how fitness and not weight is the best measure of health and you rationally prove your point against all the negative messages.  However, how does one counter those negative inaccuracies when you’re fat and not healthy, as I am?  I’m not disabled or even close to it but I have a couple of chronic health problems.  This stops me from countering all the negative comments I hear from those around me.  It makes me feel as I don’t have a right to speak up.

First of all I want to be very very clear.  The argument I’m making isn’t that “fat people should get basic human rights  if we are healthy or because we can be healthy”  What I am saying is that the rights to life, liberty and the pursuit of happiness and being treated with basic human respect are not size, ability, or health dependent, nor are they dependent on looking or acting the way that someone wants us to look or act. More details about this here.

By the way, I’m not asking that people confer these rights upon us, since they aren’t theirs to give or take.  What I’m saying is that people need to stop keeping these rights from us through the inappropriate use of power and privilege.

I discuss the evidence that health and weight are separate, and that the research suggests that our best chance for supporting our health lies in healthy habits (rather than attempting to reach a specific height/weight ratio and hoping health will come along for the ride) because I want to let people know their options.   But don’t get me wrong  – there are no habits that guarantee health for anybody of any size.  Health is complex and multidimensional and never entirely within our control.  Our health is a reflection not just of our habits and actions but also of our genetics, our environment, and our access – to strong relationships, a culture free from oppression, food and movement options of our choosing, and affordable evidence-based healthcare.

But it goes deeper than that – we talked about what happens if our fat is our fault, but what if our poor health is our fault?  Well, that’s what’s happening and we get to choose how to deal with that within our situation (and let’s be clear that everyone in our society does not have access to the same options and choices).  Regardless, it’s nobody else’s business unless we choose to make it their business.  Nobody is obligated to choose healthy habits, by any definition.  It’s none of anybody else’s business how highly we prioritize our health or what our habits are.  We do not owe anybody else “healthy” no matter what size we are.

There are all kinds of things that people of all sizes choose that don’t necessarily prioritize our health – People are allowed to jump out of helicopters wearing skis, drink two bottles of vodka a day, forgo sleep, attempt to climb mountains that nobody has ever climbed, not look both ways before crossing the street etc. But nobody is suggesting that people who don’t get enough sleep should lose their healthcare or pay more for health insurance.  My point is that this “naughty fatties need to be punished” talk is often, if not always, about trying to justify bigotry.   It’s also often done by people who insist that they should get a say in how other people live, but without any interest in people telling them how to live.

When it comes to telling other people how to live, I think it’s a bad idea. I think that if we’re interested in public health, we should work to make sure that everyone has good information and options, and then respect other people’s choices just like we want our choices to be respected.

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28 thoughts on “Fat and Unhealthy

  1. The most anger-inducing thing I see regularly in this vein is fat-shaming bullies insisting that they can’t respect people’s choices if they disagree with them — i.e., “How am I supposed to respect someone who’s eating themselves to death (’cause we all are, dontcha know) when they could be making better choices?!?!

    I’m committed to trying to explain the difference between *liking* someone’s choices/respecting the *person* and respecting the fact that their choices are no one’s business. But it sure is an uphill battle.

  2. Just this morning the guest speaker at our church was a big activist in the Locally Grown movement. She was FASCINATING to listen, engaging, knowledgeable, and what I liked best was that she admitted she wasn’t a great gardener, but she kept at it!

    Her main point was that healthy eating is a right we all have and have somehow allowed ourselves to yield over without even realising it. And being a part of the Locally Grown movement, she was all about the veg and fruit growing and how easy it is for anyone to at least try growing something. It’s a philosophy my hubby and I embrace…which is why we bought the house we did with the land we did. We produce a lot of our food (and if the neighbourhood would let us, we’d have our chickens and goats)…the goal is to have at least one thing on our table each meal that we grew ourselves.

    She went on about “the rise of type II diabetes in the country” and I braced myself for the next logical step: “And our kids are getting fatter, representing the massive obesity problem we have…” and waited for her to go sliding down that rabbit hole. We have a Talk Back after each service, and I was all set to nail her on that one, but to my incredible shock, she didn’t touch on it at all. She went on with rooftop gardens, gardens in vacant lots, “edible forests”, all sorts of interesting things.

    I like health. I like movement. I like being outside, moving around, breathing air, and I liked what she was saying. There just needs to be more of it.

    1. 🙂 I love growing food. The weather here is still too chilly to really get going on vegetables, but I was out last night picking slugs off the herb pots in the rain.

      There’s a community garden down the road from us. Unfortunately, my work hours don’t allow me to volunteer or I’d ask if they needed help. It’s always great to drive or walk by there and see how everything’s coming along, though.

      1. In England and Germany they had “allotments” because property is so expensive in cities that it’s rare you get a house with enough land to grow something. So they take places outside the city, either in the countryside or just plots of land not serving any other use and transform them into a community garden with the purpose of growing food or flowers for non-commercial purposes. It sprung up from the Victory Gardens after WWII.

        Some plots are big enough to put a shed on…others are like 5×5 spaces, but all are lovingly tended, and there’s a GROUP feel about it. You have to pay a small fee to participate, but that fee gives you a vested interest in the allotment and certain democratic rights.

        With so many American houses being so big and on good-sized chunks of land, it’s a wonder why more folks don’t plant more gardens. Since we’ve moved here, hubby has put it 25 fruit and nut trees, 20 berry bushes and vines, and built his own gigantic raised bed where we grow asparagus, onions, broccoli, peppers, spinach, squash, and probably other things I can’t remember. In the lower part of the yard we plant the things that vine–pumpkins, spaghetti squash, etc. I LOVE that my kids know where food comes from, that they can plant their seeds, watch them grow, harvest, then eat. Of course, they do get a little protective of their plants when it comes to harvest…*ahem*

        BTW, for point of reference (and I hate to burst anyone’s bubble): Georgia is lousy for growing peaches. Most of ours come from South Carolina. We actually grow really good pomegranates!

        1. chez_xeno is about 850′ and situated on a 5,000′ lot. It wasn’t my idea, believe me. My trendy “raised beds” are basically old plastic pots sitting atop cinder blocks and pallets. (All of these items were leftovers or picked up from somebody who wanted to get rid of them.)

          In the last couple of years, I’ve noticed a lot of people in the area growing crops like zucchini as ornamentals. Which is great. It is a really dramatic looking plant with beautiful blooms. Plus, nobody is likely to steal zucchini out of your yard. Win-win. 😉

  3. “…But nobody is suggesting that people who don’t get enough sleep should lose their healthcare or pay more for health insurance…”

    I think that’s because in America, at least, denial of sleep in the name of “getting the job done” is still considered a virtue. Much like denial of food is for so many of us. This is why the studied correlation between poor sleep and weight gain seems to get little traction in the media. Whereas the constant beating of the how/what-to-eat drum is loud and unceasing, no matter where you go. :/

    If more of use were getting the amount of genuine rest we needed, it wouldn’t square well with our Modern-Day Puritan obsession with work and money. There’s only one true Leisure Class in this country and it doesn’t make enough money for its own satisfaction unless the rest of us are running ourselves ragged 40+ hours a week. End of story on the sleep issue.

    1. When I was a wee thing, one full-time minimum wage job actually did provide the minimum for one person to live with the minimum tolerable amount of safety and dignity: a secure place to sleep, clean water, food whenever it was wanted, clothes that didn’t make one look desperately poor (= target and/or outsider) and means to keep them clean, transportation to and from work, some way to stay connected with one’s personal support network even if only change for the pay phone on the corner, access to important information even if it was just a cheap transistor radio, a small amount to pay for something nice on the weekend even if just a movie ticket or a bottle of cheap wine, and a little bit to put by for rainy days. Now it takes two full-time minimum wage jobs to get this–or as close as one is allowed to get to full time these days. And people who can’t hack working 70+ hours per week just to avoid sleeping in a cardboard box are called “whiners” or “entitled.” Only rich people are “entitled” to look forward to a day of rest, I guess.

      1. Yep. Even during the Nineties “boom,” it was common to see people working more than one job and still unable to afford a place to live. A pretty crummy definition of “prosperity,” IMHO.

    2. The documented correlation between lack of sleep and weight gain also doesn’t square with the popular societal narrative that fat people are lazy and unwilling to work; I think that’s another reason people largely refuse to acknowledge it.

  4. Mr. Twistie and I live in the same house, eat the same foods in similar proportions to our sizes, get roughly equivalent physical exercise, and practice similar levels of personal hygiene.

    My blood pressure is textbook perfect, I have no chronic ailments, and the last time I spend the night in a hospital, I was being born there… more than fifty years ago.

    Mr. Twistie, OTOH, has severe hypertension, type II diabetes, and congestive heart failure. He’s spent time in the hospital over the past decade for heart surgery, appendicitis, and pneumonia.

    Similar access, and even similar choices don’t always result in the same outcomes.

    But does that mean Mr. Twistis is less worthy as a human being than I am? Fuck that noise! Anyone who would try to tell me that is going to find themselves kneecapped by a short, fat, very angry woman.

    What you choose to do is only one piece of the puzzle. Ultimately, you can do everything ‘right’ and die young, you can do everything ‘wrong’ and outlive your own great-grandchildren. Most of us will wind up with a result somewhere in between. Making certain choices does give you a better shot… but ultimately what you roll in the crap game of health is largely up to who and where you come from even more than what you do.

    So to the original questioner I can only say that you are worth human rights not because of your personal choices regarding your health or what they have resulted in. No, your worth is not bound to your physical health. The reason you deserve rights is simply because you are. You exist, you are a human being, therefore you deserve human rights.

    You know, those things you’re supposed to get just for being a human.

    It doesn’t say anything in the Bill of Rights or the Magna Carta or the Geneva Conventions or the Bible about ‘you must be this physically healthy for this to apply to you.’ It applies because you belong to the species. Period.

    1. “You know, those things you’re supposed to get just for being a human.

      It doesn’t say anything in the Bill of Rights or the Magna Carta or the Geneva Conventions or the Bible about ‘you must be this physically healthy for this to apply to you.’ It applies because you belong to the species. Period.”

      Thank you Twistie. I believe this is true for people of all sizes. However, as I walk the long, therapy filled road to mental health, I have often wondered if it applied to me. I have been imperfect, I have been unkind, I have been ignorant. I have been left feeling that basic, human rights are not mine unless I am emotionally perfect. You words are resonating in me and breaking up some of those lies.

      1. Misty-eyed, now.

        Delbelcoure, we have all been imperfect, unkind, and ignorant somewhere along the line. Most of us manage to be at least one of these things pretty much every day of our lives. I know I do.

        There’s nothing in any of those documents about needing to be emotionally perfect, either. And that’s the truth to hang onto.

    2. Twistie, once again, thank you. I needed to read this right now. As I’ve mentioned on this blog before, I have congestive heart failure too, and osteoarthritis, and some peripheral neuropathy (probably from drugs for the CHF), and high glucose and cholesterol — and what it all adds up to is that I’m in enough pain, enough of the time, that walking is the only exercise I can manage. AND the CHF drugs have played hell with my balance, so I’m often wobbly and uncertain when I walk.

      Yesterday I was stepping (carefully, I thought) off the concrete steps of a little pedestrian bridge over a stream, one I’ve walked over many times before. I lost my balance and fell off the bottom step. I twisted my ankle and scraped up my elbow. I know, I’m lucky I didn’t break anything (my backpack cushioned my fall a bit). But my first reaction, as my partner was asking “Are you hurt????”, was to wail “I can’t do anything — I can’t even walk!” and I just lay there and sobbed for a few minutes.

      I’m fat, and I’m unhealthy, and it is so terribly discouraging when I’m trying to improve my health by walking, which hurts my feet and knees — and then I fall and hurt myself even worse. I have not done anything to bring any of these health troubles on myself (and Ragen reminds us it wouldn’t matter if I HAD), but I have to live with the increasing limitations they bring AND with the smug assumptions of strangers and even family that it’s my “fault” because I’m fat.

      It can be really hard not to slide into feeling completely discouraged and worthless. This blog is a godsend.

    3. What a magnificent addendum to Ragen’s formidable post.

      There are things we can do, or refrain from doing, that will contribute towards our statistical prospects of remaining alive and healthy for as long as possible, but in comparison with our genetic profile, our living conditions and access to basic sanitation, food, emotional nurture, shelter, education, and health care from conception onwards, and the capricious hand of Lady Luck, these healthy behaviours are mostly very small print. Yet because they are things we have some control over, their importance gets exaggerated out of proportion.

      The converse of this phenomenon is that when someone has health problems, the extent to which their behaviour has contributed to their less than perfect health is also exaggerated out of proportion, which is a particularly nasty form of blaming the victim for their own predicament. Whereas for every patient of mine who develops an illness that might have been predicted by looking at their lifestyle, I probably see fifty or more in whom I would never have guessed that *that* person would get *that* health problem.

      Worse, the assumption is made, often wildly inappropriately, that the health of people who have become ill will improve if they adopt the behaviours that are recommended for maintaining health in people who do not have their particular illness. There are many instances in which the last thing someone needs is a “food pyramid” diet or to take up jogging. I think well-meaning family, friends and random acquaintances are more inclined than health practitioners to take this attitude.

      I dream of a time when people can go into the consulting room of ANY doctor and be confident that their presenting problem will be assessed non-judgmentally. As things stand, I can only work on my own attitudes.

      1. About the “food pyramid” talk: I can attest that health practitioners take the same attitude as my parents, and they are both equally inclined to view me judgmentally (as well as others). Maybe in the grand scheme the way you say is true, but not what I’ve lived through.

        The last time I tried to get help for the problems I’ve been having is to get the “you’re too DAMNFAT, see a nutritionist” spiel, and then she did the same thing. She was working through their office, so I’m pretty sure she had to buy into and endorse the propaganda they were selling.

  5. Another terrific post. I am fat and have health issues. Some of these issues are directly related to choices I have made, some are not. But regardless, this article was a great reminder to me that I do not have to apologize for who I am. I am taking steps to clear up some my issues and I find both comfort and inspiration in these posts and in the comments I read. Thank you for all your positive energy! I truly helps.

  6. Hoo, boy, did I need this.

    Last Friday, I ended up in the emergency room with a gallbladder attack. Now I know why friends said things like “worse than childbirth” and “I thought I was having a heart attack” about their gallbladder attacks. The ER staff were terrific. Within an hour, I had an x-ray and ultrasound done, blood and urine samples taken, and was given IV pain and anti-nausea medication. I was diagnosed with having at least one gallstone and an infection on my gallbladder, given prescriptions for antibiotics and pain medication, and went home with a referral to one of their surgeons.

    Things went into the shitter from there. I show up at the surgeon’s private office building for an appointment five days after my attack. They don’t have my records. I am not examined in any way. They don’t check my pulse, breathing, blood pressure, eyes, ears, throat, etc. The surgeon comes in and shrugs over not having my records. He then tells me that he doesn’t think I have an infection, and that I probably don’t need gallbladder surgery. He then begins an attempted hard-sell for … you know it’s coming, folks … bariatric surgery!

    I didn’t know whether to laugh in his face or rip it off, so I let him yammer on. He said WLS would get rid of my gallbladder problems. He said I likely had a fatty liver. I finally asked how, without my medical records and no examination, he could diagnose such a condition. He said he could tell by looking at me. I said that I would prefer my medical care to be evidence-based (thank you, Ragen) and he insisted “I can tell just by looking at you” is evidence-based medicine. Once he realized that this fatty was not a sucker nor a doormat, he suggested that maybe he wasn’t the right doctor for me. I heartily agreed, took back my co-pay, and left.

    I saw my primary care physician yesterday, and he’s referred me to a specialist. He gave me a heads-up that this specialist also does WLS, but that he doesn’t do a sales job. I told the doctor that it wasn’t the mention of WLS that I objected to, I was grown-up enough to have a discussion about it, it was having my current medical situation disregarded in the vaulting straight into a sales pitch that angered me. My doctor totally understood that.

    A complaint to the hospital where I was initially treated has already been made, and I’m filing a complaint with the Board of Health. Turns out this guy already has two ethics violations (one for altering a friend’s BAC test after a DUI arrest, and one for lying later on about not having any ethics violations).

    1. How is he still working???!!!?!? My god, the things that get swept under the rug.

      Couldn’t they have just done the surgery then, since you were already at a hospital? When my dad had his last attack, it caused jaundice, and his surgery was several months later. My grandma was up in arms about how “they used to take it out right away” back in the 60s. Now I guess protocol is to take some pills and come back later(?). Seems too much like “take 2 aspirin and call me in the morning”. The “yeah whatever” of the medical world.

      I hope everything turns out alright for you in the end. I’m cheering for you!

      1. Thanks!

        Actually, it worked out fine because there was an infection in the gallbladder, which could have spread elsewhere in surgery. This way, I’ve gone through a course of antibiotics and that lessens the risk of spreading the infection. The surgeon I’ve been referred to by my PCP (we looked him up and he’s excellent) said waiting if possible also makes the surgery and healing easier. Of course, if there’s another attack, he said to go straight to (another) emergency room.

        1. Yeah, I had to have my gallbladder removed. Unfortunately, for me, I ended up with a severe case of severe pancreatitis just days before my surgery that kept me in the hospital for a week. A lot of times, after an attack like what you had, Melissa, and certainly with my issues, they have to wait because of infection and/or swelling. They try to avoid doing open surgery these days for gallbladder, and they can’t do laprascopic procedures with those infections and/or swelling.

          I’m sure you’ve already been warned, but until it’s out you should try to avoid spicy foods and anything with a high fat content ONLY because it aggravates the gallbladder and makes attacks happen more frequently. Best of luck to you, and I hope you are pain free as soon as possible. I know that pain well.


    OMG. I just saw a FB friend post a meme showing the back of a T-shirt saying: I take metformin for my diabetes which was caused by the whatever I take for some other condition, which was caused by whatever drug I take for THAT condition, and so on and so on.

    At the very end it said: “Because a healthy diet, exercise, chiropractic care, and superior dietary supplements are just too much trouble”

    WTF? Really?

    I responded with:

    Or because the healthy diet, exercise, chiropractic care and “superior” nutritional supplements don’t work for everybody.

    People with chronic illnesses have enough to deal with, without shaming thrown on top of it.

    I mean, I love it when I can be active. I like good, healthy food. But after fighting untreated autoimmune thyroid disease for five years, that shit will only take you so far.

    Not only that but, on bad days, you barely have the energy to roll out of been, much less exercise or prepare a healthy meal.

    Diet and exercise and chiropractic and supplements are NOT a panacea; they do NOT work for everybody.

    It’s also ridiculous to assume that, because someone is on a drug cocktail to treat multiple conditions (some of which are drug related), that they were too lazy to try other things first.

    My cousin has schizophrenia. One of his meds causes type 2 diabetes. He will probably need to take metformin at some point. Diet, exercise, chiropractic and supplements are NOT going to fix his brain.

    These people make me crazy.

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