Threading the Needle Between Fat Shaming and Fat Acceptance

D.A. Kirk

Outer space enthusiast. Japanese history junkie. I write about politics, culture, and mental illness. Disagreement is a precursor to progress.

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63 Responses

  1. Damon says:

    “That does not mean, however, that fat shaming is either ethically defensible or a logical approach to the obesity epidemic.”

    I can’t even get past the point of it being rude and uncivilized. That’s just unacceptable from a common courtesy perspective.

    I have some fundamental problems with the whole BMI concept and the food pyramid. The pyramid has been revised so many times, and doesn’t really reflect the variations in humanity. I put on weight eating carbs for instance, all other things being equal. I’m technically considered obese due to my bmi, and really should be 180 pounds, but I have legs like tree limbs, and the cardio and physical strength to spending 30 minutes doing full rolls in jujitsu (that’s 5 rolls) . Even if I lost all my belly fat, at best I’d still be considered over weight. This strikes me as fundamentally wrong.

    Nothing above in my comments doesn’t mean that I’m “healthy” or “normal” or that america doesn’t have an obesity problem, nor does it mean that a bad bmi calculator is the main cause of the problem, but none of that is actually doing anything to help the problem. When Arnold Schwarzenegger is considered obese by BMI when he was “the terminator”, the tools aren’t valid on the wings of the distro curve.Report

    • pillsy in reply to Damon says:

      BMI is a terrible way of telling whether individuals are obese, but an upward trend in average BMI for a population is a reasonable sign that the people in that population are getting fatter.

      People who know better still use it as a guideline for individuals, though, because computing it requires two easy measurements and no complicated math. This doesn’t really do anybody a hell of a lot of good.Report

      • fillyjonk in reply to pillsy says:

        +1. It was designed as a population-scale measure (so: like an average), not a tool for individuals.

        For me, talking about weight and diet is a fraught topic. I am a heavy woman, though I have had people tell me I don’t “look fat.” (Part of it is, I have a lot of muscle, and muscle is heavy). I wear about a size 14/16 US, which is considered “average” now, I guess, but which some people consider “too big.” I have a gut, and I hate that I do. I hate that my boobs are as big as they are.

        I’ve had experiences of being yelled at (by a podiatrist) for my weight and for not doing more exercise. I once had a GP – when I had gone in solely to get a flu shot – offer to prescribe Fen-Phen for me (that was back like in 1999, before the side effects were fully known). I said no, but….I wonder what would have happened if I’d said yes, and then turned out to be one of the ones whose heart valves got borked from it.

        After that last experience? I went without a GP for a dozen years. My “annual checkup” was the check at the gyn, which is not really complete. I only found an internist after the blood-donation people wouldn’t let me donate blood because they said my blood pressure was too high, and I figured “I guess I *have* to brave going to a doctor and be told I must lose weight, with medication if necessary, or else have a blood vessel in my brain explode some time.”

        I got lucky, though: found a DO who was more interested to hear that I try to work out 40 minutes a day and that I was willing to try the DASH diet (not for weightloss, for blood pressure control). I’ve been going to this doctor for six years now and she’s never once told me I have to lose weight or yelled at me for being fat, instead, she commented that what I listed as my ‘favorite vegetables’ (when she once asked me) were “good choices because they cover the range of needed nutrients well”

        That’s actually more of an encouragement for me to keep eating beets and sweet potatoes and the like than it is for the doctor to say “Okay, now, what you have to do, is get it so all you eat in a day is beets and….can you sub squash in for sweet potatoes? It’s lower in calories?”

        To me – I’m not a psychologist – but it seems that encouraging people in whatever steps they are taking, and then gently suggesting more, is more likely to gain a positive response than passing judgment or saying “Why don’t you just….”

        Most of us fatties, we KNOW what it would take to lose weight*. It’s just….for some of us it is harder than you can imagine to implement.

        I’ve also had food issues in the past: in college, in a mad attempt to slim down, I went on a 1200 calorie a day diet, where I wrote down everything I ate and couldn’t eat it unless I wrote it down. (Yes, I know now this is a disordered behavior, don’t @ me). I was hungry all the time and was miserable,a nd probably was miserable to be around. When it gets to the point when you are starving, but wonder if you can “afford” the extra 70 calories in a hard-boiled egg….well, that was the day I threw out my notebook and said “Fish it, if my body wants me to be kinda fat, I’m gonna be kinda fat.”

        That said – you can do what you can to stay healthy. Which is why I get up early most mornings of the week and use a giant chrome and wood contraption to pretend to cross-country ski even though I’m actually going nowhere, or fling my limbs around while some guy with what might be a hokey Caribbean accent cracks jokes while exhorting people to give him a few more reps…and why I stuff in the damned beets and spinach even if I really want a cheeseburger.

        But of course, I’m a slob and un****able and all that because I’m not a size 4. Fish humanity.

        (*Though more and more, I wonder if genetics and body chemistry and gut flora play as big a role as “calories in vs. calories out”)Report

        • D.A. Kirk in reply to fillyjonk says:

          “To me – I’m not a psychologist – but it seems that encouraging people in whatever steps they are taking, and then gently suggesting more, is more likely to gain a positive response than passing judgment or saying ‘Why don’t you just….'”

          I’m no psychologist either, but I can very much relate to this. I have a very severe form of OCD that made it immensely difficult for me to quit smoking. I eventually managed to pull it off, but it took more than a decade, and it only happened because of a brief period of time when my OCD sort of went into sleep mode for a bit. Before that, though, I had to deal with a fair amount of shaming, and I found it downright bizarre when people thought they could simply talk me out of the habit by making condescending, judgmental remarks. After a while, I started to find it quite amusing, to be honest.

          It really all comes down to sincerity. There are of course people who are genuinely concerned for your health, but then there are the narcissistic types who are less interested in your health than they are with reaffirming their sense of superiority by passing judgment on anyone who doesn’t conform to their standards of awesomeness. I suspect you’ve had to deal with a lot of people in that second category, and I’m sorry for that. I imagine you’ve grown quite tired of dealing with it, as I imagine most people would were they in your position.Report

    • D.A. Kirk in reply to Damon says:

      “I can’t even get past the point of it being rude and uncivilized. That’s just unacceptable from a common courtesy perspective.”

      Personally, I agree with you. But over the years I’ve learned that some people actually believe that shaming is the decent thing to do because, in their minds, it’s a good way to pressure people into taking care of themselves. Once you take that excuse off the table, there’s nothing else left for the shamers to rely on to justify their behavior. That’s why I focused on debunking that particular myth instead of just talking about how hurtful and cruel fat shaming can be.

      On the topic of BMI, I agree it’s not very useful when you’re trying to assess an individual’s health. I do also agree with pillsy’s comment below, though. The upward trend regarding BMI averages in the U.S. does seem to reaffirm what doctors have been saying about the recent uptick in obesity. In that context, I think it’s a somewhat helpful benchmark. It’s just not something I’d rely on when trying to figure out what my own weight should be.

      Thanks for taking the time to read and comment, by the way! I sincerely appreciate it!Report

  2. Em Carpenter says:

    This is a fair perspective, so the following comment is not so much aimed at the author as those who concern-troll.

    I think there is a difference between fat acceptance and encouraging unhealthy behavior. I see the former as meaning that even morbidly obese people deserve to feel good about themselves and participate in society. Their health is their business (setting aside the “but muh health care costs” argument that always follows). I don’t see anyone advocating or encouraging people to become obese.

    When Tess Holliday was on the cover of Cosmo a few months ago, many people just absolutely revolted at the idea that a really large (and ok, probably unhealthy) woman should be allowed to grace the cover of a magazine normally reserved for the traditional waifs. What the critics said was “but this just encourages and normalizes being unhealthy!” What they really meant was that Tess didn’t deserve the recognition reserved for the traditionally attractive. She didn’t deserve to inhabit the same space as thin, traditionally beautiful women. Nobody actually cares whether Tess Holliday loses weight; they just can’t stand the thought that she might not hate herself the way they think she should.
    As for normalizing being unhealthy- look around. Sadly, it already is normal, and changing that is a worthy goal. But fat acceptance, as I see it, does not create the danger that anyone is going to decide that morbid obesity is their goal because they want to look more like Tess Holliday than… well, whoever is considered a supermodel these days. No one aspires to being fat (excepting some weirdo fetishists).

    I agree that “healthy at any weight” taken to its extreme is not a good message. But being accepted at any weight is. Advocating healthy food and activity is wonderful, but a person’s size and health is between them and their doctor.Report

    • bookdragon in reply to Em Carpenter says:

      Regrading the reaction to Holliday, I also never saw “but this just encourages and normalizes being unhealthy!” back when nearly everyone on covers looked anorexic. My teens years were during the height of the era when the ideal of female beauty was being nearly skeletal. Girls who wore a size 4 were ‘cows’ and that lead to a different but equally unhealthy message. Indeed, that one was worse since as you say no one is going to aspire to be morbid obesity. However a lot of girls did real damage to their bodies trying to aspire to be Twiggy.Report

    • Damon in reply to Em Carpenter says:

      I remember that cover.
      Frankly, I don’t think she’s attractive at all. But my opinions of what’s attractive are that..mine.

      However, there are reasonable objective historical data points on what is considered attractive.
      I think it’s fair to say she’s outside those historical norms..Report

      • Em Carpenter in reply to Damon says:

        OK, but what’s your point?Report

        • Damon in reply to Em Carpenter says:

          “there are reasonable objective historical data points on what is considered attractive.”

          She doesn’t fit that bill.Report

          • Em Carpenter in reply to Damon says:

            …..and? So?Report

            • Damon in reply to Em Carpenter says:

              “What they really meant was that Tess didn’t deserve the recognition reserved for the traditionally attractive”

              And they were correct. She’s not attractive by an historical metric.Report

              • Em Carpenter in reply to Damon says:

                No, they are not correct. You don’t have to be “traditionally attractive” to be beautiful and be recognized for it.

                How incredibly shallow to think only “traditional” beauty belongs on the cover of a magazine.Report

              • Damon in reply to Em Carpenter says:

                We’re not going to get far with you arguing that’s she’s attractive. Shall we line up 3 thousand people and conduct a poll. I doubt many will find her attractive.

                Shallow? OK…that doesn’t change the facts. There’s a reason why historical parameters of beauty haven’t changed much….they are fundamental to human nature.Report

              • Chip Daniels in reply to Damon says:

                I want to see an episode of Black Mirror where one morning all men wake up to discover that their income and job title is displayed across their foreheads, so as they walk through the world, everyone can see exactly their social rank and position which is, as we all agree, fundamental to human nature.Report

              • atomickristin in reply to Damon says:

                Just to reiterate Em’s point – so da-f WHAT? I sort of feel you’re missing the entire point of her question, probably deliberately.

                So let me elaborate. Does a woman have to be attractive to be on a magazine cover? is it a prerequisite? Because if so you’ll be eliminating a lot of very successful women from being represented on magazine covers. Tess is a FASHION MODEL who happens to model clothes for plus size women and just as any model, she has every right to be on the cover of a fashion magazine. As a celebrity, she has every right to be on the cover of Cosmo.

                I mean seriously – does everyone have to agree that a woman is objectively attractive to be on a magazine cover? When did that become a rule?? Because I certainly see a lot of women (not to mention men) who I don’t find at all attractive on magazine covers. There are many, many actors, both female and male, athletes, musicians, and models I find honestly hideous looking who are on magazine covers every day. I think Matthew McConahey is freaking repulsive, for example, but he’s on magazines all the time. And so what? I am not the arbiter of the definition of the word “attractive” and I can understand that “attractive” means a lot of different things to a lot of different people. There is room in the world for more than one definition of the word attractive.

                The thing is, Tess is singled out here because she’s a big girl. That’s the only reason. Whether or not you agree she’s attractive, we look at ugly and unhealthy people on magazines all the time. Skeletally thin women, dudes pumped up to monster size on steroids, people who are Botoxed within an inch of their lives, people who are chronically drunk or high on drugs, people who are on covers to represent all manner of cultural agendas – many of whom are unattractive ~to me~ and many of which are promoting “unhealthy lifestyles” tons of which kill a person way faster than obesity does – and none of us blink an eye. But then as soon as a woman with some meat on her bones shows up 80% of everyone has a meltdown about her being there. It’s ridiculous.

                And about “attractive”. Within my lifetime the window of “attractive” for women has shrunk to about the size of a paper clip and it’s always moving. It takes a small fortune, being in a microscopic window of youth, and hitting the DNA lottery to be “attractive”. `”Attractive” in 2019 (as defined by being worthy of being on the cover of Cosmo) is unattainable for most women. Even thin ones.
                So take ur historical parameters of beauty and shove em, because in NO previous historical incarnation of the word “attractive” did women ever have to jump through the hoops that “attractive” in 2019 requires. Thousands of dollars in product per year, hours of makeup and hair every day, surgeries and injections and personal trainers and eating bizarre diets – no one did that ever in history, ok??? Marilyn Monroe wouldn’t be called “attractive” using the 2019 definition. Cleopatra wouldn’t be called “attractive”. You could take the most beautiful woman in the world in 1919 and plop her down here and a whole lot of men would be all like “WTF is with that dog? you can tell she doesn’t work out” What is going on right now is not natural, it’s not historic, it’s not ingrained into us by evolution, it’s totally weird and artificial and malignant and it deserves some pushback.Report

              • dragonfrog in reply to Damon says:

                “What they really meant was that Tess didn’t deserve the recognition reserved for the traditionally attractive”

                And they were correct. She’s not attractive by an historical metric.

                Emphasis mine. You’re missing the point. Just read, grammatically, what the sentences are – the one you quote, and what you think is your agreement with it.

                The sentence to which you respond is about her deservingness of recognition, quite apart of any qualities of attractiveness. Your response is about her attractiveness

                It’s not “Is Tess Holliday attractive? (to persons unspecified),” it’s “Does Tess Holliday deserve the recognition of appearing on the cover of a magazine in which the feature article is an interview with her, whether or not persons unspecified find her attractive?”

                The distinction is important. An answer about someone’s body’s degree of conformity to recent historical Western notions of beauty, fails to address a question about the categorical imperative.Report

    • Pinky in reply to Em Carpenter says:

      I assume that the usual Cosmo cover makes women feel bad which motivates them to eat more, and that the picture of Tess Holliday looked so bad that it scared women into eating less. I could be completely mistaken; psychology is weird, especially related to food. But that Cosmo controversy summed up how our society is about women and weight. We constantly promote unhealthy thinness, except for the moments that we endorse unhealthy fatness. The virtue of the middle is strictly avoided.Report

      • Em Carpenter in reply to Pinky says:

        For me, personally, I thought “how great that they can recognize and promote the beauty that exists even in a woman like her.” I thought it might make women like her feel better and more confident about themselves- which is a good thing, because confidence and self-esteem can actually be a catalyst for people to do better for themselves. When you like yourself and feel good, its easier to want to do good things for yourself, like improve your diet and exercise. One can simultaneously feel good about one’s self and still want to improve.

        It doesn’t mean I, or those women who are like Tess H., saw her on Cosmo and suddenly thought there’s nothing wrong with carrying that much weight or that it’s healthy and we shouldn’t take care of ourselves and try to be in better shape.Report

    • D.A. Kirk in reply to Em Carpenter says:

      “Nobody actually cares whether Tess Holliday loses weight; they just can’t stand the thought that she might not hate herself the way they think she should.”

      I agree a lot with this. There’s a nasty strain of narcissism that runs through a portion of the fat shaming crowd, and I think that was reflected in some of the reactions to the Tess Holliday cover. Holliday clearly doesn’t follow the strictly regimented lifestyle that some of her critics promote, and they take it personally because that lifestyle is what transformed them into the “ideal” men and women they believe themselves to be. And when they can’t handle the idea that not everyone wants to be or look just like them, their only recourse is lash out like they did when Cosmo ran that cover.

      “But fat acceptance, as I see it, does not create the danger that anyone is going to decide that morbid obesity is their goal because they want to look more like Tess Holliday than… well, whoever is considered a supermodel these days. No one aspires to being fat (excepting some weirdo fetishists).”

      On this point, I have to respectfully disagree. Well, kind of. On the one hand, I agree that the fat acceptance movement isn’t going to make people *want* to become obese, nor do I believe that that’s one of the movement’s goals. On the other hand, I am a little concerned that the movement is at least partly responsible for inadvertently discouraging some people from trying to lose weight. And if I’m correct about that, the timing couldn’t be worse considering the current statistics on obesity.Report

      • Em Carpenter in reply to D.A. Kirk says:

        I understand your logic, but I don’t think it’s reality.

        Fat is never going to be seen as preferable to fit, and while some people may say gee, I’m fine just the way I am, I don’t think it will ever override the pressure to be thinner.Report

  3. LeeEsq says:

    I think article really misses the point about what the body positive movement is about because it doesn’t refer to feminism. From my observation, the entire body positive/fat acceptance movement stems from the fact that women have been under a lot of pressure to achieve the ideal body from men. The movement is about making women feel fine as they are. It explains why very few men feature in body positive ads and why the problems faced by short men like myself, I’m 5’6″ in height, aren’t really featured. Women don’t want to examine their physical preferences any more than men do, more than a few see short men as deficient in some way, and tall men aren’t going to give up their advantages.Report

    • bookdragon in reply to LeeEsq says:

      Part of that may be that weight is something that is perceived as being completely under the individual’s control, and thus something they can be shamed for, height is not something that diet or exercise will affect. Nor does height have the same significant impact on health.

      Which is not to say that I’m not sympathetic. Being a tall woman, I experience it from the opposite side. Despite the popularity of Wonder Woman, those of us that resemble Amazons in being tall and more muscular are still generally considered less desirable and ‘feminine’ than women who are petite dainty waifs. (Side note: though my husband is tall, one of the most physically attractive men I ever dated was a wrestler who was considerably shorter than I am. He dumped me, and though it probably wasn’t entirely because of the height differential, the girl he immediately took up with was shorter than he was).Report

      • LeeEsq in reply to bookdragon says:

        Despite being beyond your control for the most part, unless you are willing to undergo some really radically surgery with a long recovery time, height is something that is used to shame short men. For instance, when you say that is might big of someone you mean it as compliment. When you call somebody, particularly a man, little, you mean that they are petty and ungenerous. A lot of the insults hurled at Jeff Sessions for his sheer meanness aimed at his height. He was called an evil Keebler elf, etc.

        Plus I find that a lot of media tends to treat short men as a walking joke. The annoying male character that hangs around that nobody particularly likes is often shorter than the other men in the cast. To fail to grow to average height is to be seen as boy-life, immature, and fundamentally unmanly. So short men are often seen as pathetic, petty, or both.

        The height issue for women is more complicated. In the past, there was definite belief that women should be petite and dainty, hence shorter. However, tall women with the right look are often seen as stunning and statuesque. Granted this requires a lot of factors to be working in the women’s favor. However, being tall can also work against a woman, especially if they are considered insufficiently physically attractive.Report

    • D.A. Kirk in reply to LeeEsq says:

      Very fair point. You’re absolutely right that the fat acceptance movement is inextricably linked to feminism, though I would argue that they’re not necessarily one and the same. I didn’t dive into that aspect of the discussion only because I was more interested in the practical implications of the movement’s growing success than its ideological underpinnings.

      I also certainly do agree that both women and men should be accepted regardless of any of their physical attributes (height, weight, and so on), that they should be encouraged to love and respect themselves, and that the body positivity/fat acceptance movement is right to promote that mindset. That said, I am concerned that the movement might be inadvertently encouraging some people to skip out on doing things they otherwise would be doing to improve their health.Report

      • LeeEsq in reply to D.A. Kirk says:

        The body positive/fat acceptance is only a part of feminism but dealing with its’ negative component requires that the link be recognized. Doctors are not going to convince people to pay attention to their health by ignoring the reasoning behind body positive/fat acceptance.Report

  4. LeeEsq says:

    This Vox article from a few months ago is about the problems that short men face in buying clothing. One would think that the body positive movement would be on this issue but it seems to be of little interest even though there are 30 million adult men 5’8″ and shorter in the United States.

    • Jaybird in reply to LeeEsq says:

      If you see “Body Positivity” as intrasexual competition, it makes more sense.

      (It also helps explain why it’s more socially acceptable for women to do it than for men to do it.)Report

    • Saul Degraw in reply to LeeEsq says:

      OT but I find this series interesting because it often seems like advertisements hidden as white papers.Report

      • LeeEsq in reply to Saul Degraw says:

        The Good Series are basically advertisements wrapped up in the form of a discussion on some social issue. Vox being Vox can’t do a straight up consumer reports type article. Just simply writing about places where short men can by fashionable clothing or why GOOP style health products are nonsense would be too much for them. They need to hide it behind some sort of issue or policy analysis.Report

    • Road Scholar in reply to LeeEsq says:

      FWIW @leeesq , being taller than average isn’t much better when it comes to clothes shopping. At 6’3″ I’m not freakishly tall but I have considerably less selection off the rack. I have a really hard time finding shirts and jackets with sleeves that are long enough. And don’t get me started on finding shoes at size 13W.

      I’m not sure what the actual statistics are, but the mass retail clothes industry is geared to that one-sigma around the mean and we both fall outside that.Report

  5. Jaybird says:

    As a person of size, I find myself vaguely irritated at society for a number of things related to assumed smallness. Airplane seats, for one.

    That said, I look at pictures from the 70’s and 80’s and there are people who were considered “fat” back then that wouldn’t get that description today.

    I suspect that there is a handful of things that have changed (or accelerated) since then (and the food pyramid and the weird emphasis on putting HFCS in everything both strike me as necessary (but not sufficient) pre-reqs for where we are today) and I have no idea how we, as a society, would turn things around short of drastic measures.

    I mean, just saying “what was food policy back when everybody was skinny?” followed by “let’s try that?” would qualify as drastic to the point where it wouldn’t be feasible.

    And so we’re stuck in a place where we are stuck between two groups of people arguing about this as if it were a moral argument rather than an engineering one. Ugh.Report

    • Pinky in reply to Jaybird says:

      It’s more a matter of availability than of policy, I think. Sure, there are policies that could be improved. We subsidize corn so much that we’ve essentially replaced sucrose, and we still have enough corn left over to burn. Literally, burn. Our cars run on burning food. And the food doesn’t even burn well, and it messes up our engines. But mostly, it’s that food is available everywhere, and it’s well-marketed, and we don’t even really need marketing to convince us to eat stuff that’s bad for us. We’re not the only species that eats itself to death.

      What we need is discipline, and I’m not saying that to fat-shame; if anything, I’m saying it to parent-shame. I have much respect for the parents who do a good job, but there are plenty who don’t. If the parents never learned to manage their health themselves, then an education policy could help. But…actually, I’m going to digress now, and write about how similar this topic is to the recent discussion about government furloughs. There’s a lot of overlap. Everyone likes expensive stuff and extra servings, and parents have a difficult task in trying to help their children develop impulse control. We’ve never had access to this much stuff, or credit, or soda. It’s tough.Report

    • DavidTC in reply to Jaybird says:

      It’s not HFCS. Or, it is but we’d be in exactly the same place if we used sugar instead. The problem is that, way in the past, we decided that fat in food was bad, and started taking it out of foods that really should have it. This made food tasteless, so we started adding in sugar (Or HFCSs) and salt…both of which was _much_ worse for people than fat. And they’re addictive, which fat isn’t.

      We also, at some point, figured out there wasn’t a point in making everything low-fat, so we started adding small amounts of fats _into_ things…trans fats. For no real reason other than they were easy to make. While not changing the foods we’d already stripped fat from.

      We even insanely decided that margarine, which we’d invented due to milk shortages, was healthier than butter, which…no, it wasn’t. Margarine now is somewhat healthy, although it still lacks nutrients…but the original stuff…man. It was basically just transfats and salt.

      Basically, half of our problem with the nutritional content of food is due to our nonsensical ideas about fat in food, and what we did to stupidly replace it. The effects of which have hung around an extremely long time even after we’ve figured things out. Fat, cis fat in food that are naturally fatty, is mostly fine to eat, and we would have been much better if we’d just kept eating them. Instead, we rejiggered the entire food supply due to worries about them. We spent _decades_ doing literally negative things in the name of health.

      The other half of our problem is less solvable and is due to factory food and preservation and fast fooking and whatnot. But that, at least, isn’t us shooting our own foot off.Report

      • Jaybird in reply to DavidTC says:

        Basically, half of our problem with the nutritional content of food is due to our nonsensical ideas about fat in food, and what we did to stupidly replace it. The effects of which have hung around an extremely long time even after we’ve figured things out.

        I don’t understand why having figured things out hasn’t really resulted in any change.

        I mean, I’m as cynical as anybody and we were able to change things when we thought that fat was bad. Why in the hell can’t we change it now that we know it’s not?

        The only explanations left are conspiratorial thinking and that’s crazy talk.Report

    • D.A. Kirk in reply to Jaybird says:

      Good point about the policies attached to this issue. It’s really kind of crazy that we impose these huge sin taxes on stuff like alcohol and tobacco while simultaneously subsidizing the junk food/fast food industries.Report

  6. Stephanie says:

    As a health care provider I was often in the uncomfortable position of doing peoples’ physical exams and seeing that someone’s weight was in an unhealthy range and that the appropriate advice would be for them to try to address that in some way; mentioning, of course, the unmistakable risks of very undesirable (expensive, painful, life shortening) health conditions in the future. After 40 years it’s obvious that obesity, once rare, is almost the norm now.

    It’s almost impossible to talk to people about this very complicated issue, no matter how diplomatically, as there is an automatic negative reaction. It’s very sad–this reaction is due to what was said to them by parents or peers early in their lives. Worse, some people are dealing with histories of emotional, physical or sexual abuse which underlie their overeating.

    Although well intentioned, the “body positive” attitude has no relationship to health concerns & only results in people defensively saying, “I like myself this way.” The body positive movement doesn’t allow for people not being happy being overweight (my experience is that most are not happy that way) and doing something about it. The self esteem issue & fat shaming problem is a totally separate thing and valid, but obviously having an awareness of needing to lose weight and simultaneously feeling happy about being a large person seem to generate a cognitive dissonance.

    Of course, overweight people are treated unfairly. Other people may be abusive, alcoholic, drug addicts, very stupid, etc., but are able to keep that hidden from the general public, but we don’t hear about alcohol-shaming or stupid-shaming.

    I disagree about BMI. It ends up being most helpful when explaining to parents what a healthy weight for their child should be. These days, it appears that many parents are inadvertently overfeeding their children. BMI gives a target range/ballpark estimate, even for adults. So many people are obese that a slender person of normal weight looks abnormal while a larger body looks like the norm. And most people are not bodybuilders like Arnold.Report

    • D.A. Kirk in reply to Stephanie says:

      Thanks a ton for your insights, Stephanie!

      Your comment about the disorders/traumas that can lead to overeating really hit home with me. I’ve maintained a pretty healthy weight for most of my life, but there was a two-year period when I was good 30 or 40 pounds bigger than I should have been, and that occurred right after the onset of my OCD. Fortunately, I dropped the extra weight quite quickly thanks to all the sports I played. But I’ve seen the same thing happen to many old friends of mine who suffer from severe psychological and neurological disorders as well, which is perhaps why I’m so hyperaware of the link between weight and mental health. It’s also one of the reasons why I’m so adamantly opposed to shaming as a response to obesity. At the same time, as you already explained, we seem to be at a point now where we can’t even acknowledge the facts about obesity without being accused of insensitivity, or, even worse, some vague and indirect form of bigotry/discrimination. That’s a huge overreaction to the problem of fat shaming, and a dangerous one at that. I think we’re very much guilty of overcompensating for the past unfair treatment of overweight people, and I’m afraid the problem is only going to get worse if the body positivity/fat acceptance movement doesn’t take a moment to reconsider its approach to this issue.Report

      • Dave in reply to D.A. Kirk says:

        “…and I’m afraid the problem is only going to get worse if the body positivity/fat acceptance movement doesn’t take a moment to reconsider its approach to this issue.”

        Based on what I’ve read out of modern fat activism, it’s never going to happen.Report

    • Maribou in reply to Stephanie says:


      As far as BMI goes, it’s a broken tool. A slender person of normal weight (according to BMI) is statistically likely to have worse health outcomes than an “overweight” one. (Obese/morbidly obese is of course a different ballpark.) Do you recommend parents with children who are normal weight encourage their kids to put on a few pounds? or that “normal” folks themselves put on a few pounds? I suspect not.

      The thing that is most tightly correlated to obesity / morbid obesity in adulthood is significant childhood trauma. Obesity for these folks (self-included) is a co-symptom of continued suffering, perhaps the only one high-functioning folks can’t mask in an attempt to please their doctors, not the origin of the other symptoms. Trying to treat obesity without treating underlying previous trauma *first* fails the vast majority of the time. You even mention this underlying history – but you still think you should worry about the symptom first, not the emotional scarring from the history? If folks have this history, why would you contribute to it by critiquing their weight rather than seeking to increase their support system & mental health? (Perhaps you don’t do this! But it sure sounds like you do from the way you frame advising patients above.)

      Related to this or independently, almost *everyone* who loses weight according to doctor’s orders (or otherwise) puts it back on within 5 years. Even those folks who haven’t (by self-report, obviously) experienced any significant trauma. People who lose weight and stay at the lower weight for more than 5 years are rare exceptions, not easy-to-emulate role models. People who lose more than 50 pounds and stay at the lower weight for more than 10 are total outliers.

      These are known facts, not body-positivity jargon (which is sometimes helpful, sometimes ridiculous). How are you giving the best medical care if you approach obesity without embedding your actions – what you actually say to patients and what interventions you encourage them to make – in this larger context, rather than just “oh, by the way, since you’re here, I’m going to make you talk about this extremely fraught subject even though I know [or should know] it probably won’t help to do so and may harm you?” And you think getting a defensive reaction to that is because there’s no way to be diplomatic enough due to their past history? I think you should reconsider.

      I’m not asking doctors or other medical professionals to go all pro-chub, but very very few medical professionals show any practical awareness of either of these two things, regardless of how sound and solid the body of research demonstrating them has become. It greatly discredits most medical providers’ approach to obesity, in the eyes of obese people at least, and has far more to do with why people are defensive toward doctors and don’t want to talk to them about weight issues than anything else does.

      People going “too far” in search of body-positivity is not even a drop in the bucket compared to medical providers who don’t think about the consequences of their actions when it comes to advising patients about weight. The idea that the latter is overwhelming the former is … dubious at best. A function of confirmation bias.Report

      • Maribou in reply to Maribou says:

        PS as a person who has lost drastic amounts of weight unintentionally due to trauma-related stress, and also gained drastic amounts of weight while exercising above recommendation and eating as recommended, due to trauma-related stress, and also avoided getting any healthcare whatsoever for 6 years due to fat-shaming by a doctor *during a gynecological exam* …. outright shaming, not just bringing it up….

        I am torn between not even bothering to talk to medical professionals about this issue and being aware that my *current* doctor is really great and has learned a lot and shaped her approach to all patients differently because she respects my scientific background and research skills (I’m a librarian).

        I hope you can take my rather harsh comments as having to do with hoping that you can also learn and change and be more helpful – and that you want to do that – and not as an indication that I assume you are terrible. Which I certainly don’t. Even being aware of obese folks’ likelihood of traumatic history puts you miles ahead of most medical professionals I have come across.Report

      • Stephanie in reply to Maribou says:

        Re: paragraph 1: I challenge you to show some solid research to prove that statement. You are in denial of the problem. I also see no solid research to prove your statement of paragraph 3. Also, you are so upset about my even talking about the subject that you did not pay attention to what I was saying. You seem to assume that I am bringing up the subject of weight in an offensive way. That actually proves my point about how defensive people get, no matter how the subject is brought up.

        I am interested in seeing the science behind the statements you are saying. Prove to me that health professionals have no business considering obesity a risk factor for heart disease, hypertension, arthritis of weight bearing joints, cancer, diabetes, slow recovery from surgery, and in general a shortened life span. If you can’t, then give me a nice script for discussing the subject.

        You have a basic misunderstanding of health issues and the responsibility of providers to give objective information, although obviously in the most palatable form possible. My point is that there is NO palatable way to give this information to some obese people. We have the same problem with smoking and the same defensiveness. Also, with alcohol misuse.

        No matter how compassionate you may be, it’s a basic truth that there are certain problems that people do NOT want to acknowledge and get extremely defensive when they are mentioned. In a social setting I mind my own business. But it’s different for a health professional. I have no skin in the game. It doesn’t harm me if people don’t change unhealthy habits. However I’d be a lousy provider if I ignored these things.Report

        • Maribou in reply to Stephanie says:

          Why should I expend the effort to show you solid research? I’m at work and mostly busy. You didn’t show solid research (or any research) to support your claims. You certainly don’t show any evidence of being well-read across the spectrum of results, rather than cherrypicking those studies that support your claims while ignoring anything else. I mean, that’s all I would have time or space for here, anyway, cherrypicking, but you don’t even do *that* much in your comments. “I’m a medical professional” is not, any more, a reason to get away with not being up on the literature, all the professional literature, not just what you agree with.

          I’m actually not upset at you at all, but you misreading my stark disagreement as upset is not surprising. My assumptions – which I undermined myself on purpose and which you confirmed pretty well lower in these threads as being likely – were not a result of me being upset, but of a lifetime of experience of medical professionals, not just treating me but treating lots of other people I’ve been in the room with. Particularly those, like you, who are deeply misinformed about what their *priorities* around risk should be, and also a huge number of medical professionals who, unlike what you claim to do, don’t even bother with being gentle or kind to those they treat. I never said “no business considering it a risk factor”. I said, “no business treating it as the best risk factor to address first, no business bringing it up in cases where there’s a major abuse history or pressing it if the patient communicates that you’re treading on their abuse triggers – rather than addressing the support they can have for the emotional pain *first* and only bringing weight into it once that’s addressed – and no business *in most cases* treating it as a disease of its own rather than a co-correlated symptom of other, more urgent problems.” Actually I didn’t even say most of that latter stuff, but I will happily do so now.

          There is no palatable way to share information about weight with someone who *ought* to be getting in depth mental health care instead, first, far more urgently, this is absolutely true. There is no palatable way to interrupt a gynecological exam, for example, as was done to me by a respected medical health professional who is still working, in order to provide *unrelated* medical health information by literally verbally shaming the patient (“you have no excuse for being this fat” was the *beginning* of her speech), this is also true. There’s no palatable way to mistreat patients due to lack of information and inability to re-examine one’s assumptions regularly, through not keeping up on the literature and reading it broadly and *critically*, as any science-and-evidence based practitioner *should* be able to do. No matter *how compassionately* someone treats them poorly, they will NOTICE and be pissed off at being poorly treated. Most of the time, they’ll just stop showing up. How is that helping? It’ll sure improve metrics though.

          I’m not pissed off at you, I’m just hoping to shake you enough to get you to take this aspect of your work with a more skeptical viewpoint and do some of your own research.

          That’s what I have time for, today. I don’t have time to teach you to do the stuff that should be part of your job, whatever your reasons for not doing it are. (they may be excellent ones. we all have our stuff.) Or to do that part of your job for you.

          If instead of taking what I’m saying as a reason to re-examine your process around obesity and health, you choose to blow it off as yet another fat person who can’t take being confronted with reality, that’s on you, as a medical professional, not just socially.Report

          • Maribou in reply to Maribou says:

            Because I actually do care about improving health care outcomes, not just telling you that you are someone wrong on the internet, and because BMI is a lot easier to dig up information on without having to deal with retraumatizing material:

            This is a solid review of just SOME of the issues around BMI:
            If that doesn’t make you cautious about treating “overweight” now known as “preobese” people in the BMI, as needing medical counselling, I don’t know what will.

            Furthermore, no less an authority than the freaking CDC – surely we still believe in them right? – has this to say about BMI:
            “BMI can be used as a screening tool but is not diagnostic of the body fatness or health of an individual.

            To determine if a high BMI is a health risk, a healthcare provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings10.”

            Surely advising parents to change how they feed their children is *treating something as a health risk*. If you really are doing all those other things before using BMI, why the heck did you stand up for it without mentioning any of them?Report

            • I’ve told this before, but at my peak of physical fitness ability I was active duty, running 2-3 miles a day, religious with the weight room, had a 32 inch waist but at 5’9 and 215-225 pounds depending I was always 31-33 on the BMI charts and “obese.” The chart said obese, real life I was at my best. The key is in what you said, it is a tool. The service at that time used it to screen, then you would go in, tape, they would review the totality of your fitness and off you go if all was in order. If you number was high and you weren’t meeting PT standards you were remediated to correct the problem. There is, and never will be, a one size fits all measurement for human health based soley on numbers.Report

              • Maribou in reply to Andrew Donaldson says:

                @andrew-donaldson This one isn’t just a tool though, it’s a broken tool that does less well than other tools we have at achieving the same outcomes, particularly when it comes to folks in the so-called “preobese” category. Why use a broken knife to screw in a screw if you have screwdrivers and drills available? “This knife worked better than what I had around in the 1920s, so I’m going to keep using it in this century too.” is not, IMO, a good answer.

                See the article I linked to for more information.Report

              • Maribou in reply to Maribou says:

                (to be fair it’s more like we have only have electrical drills available and the HMOs’, etc., response, which trickles down, is more like “but we can’t AFFFFORD the electricity for the drills.” we can’t really afford to keep using this broken rusty knife, though, either? not if we give a crap about overall well-being and not just physical metrics.)Report

              • Maribou in reply to Maribou says:

                It’d sure be nice if somebody could figure out some screwdrivers (simple, affordable, more accurate). Though of course if they did the other issues I raised would still pertain.Report

  7. Em Carpenter says:

    “The body positive movement doesn’t allow for people not being happy being overweight (my experience is that most are not happy that way) and doing something about it.”

    I disagree here- body positivity doesn’t mean you shouldn’t strive for good health- just that you shouldn’t hate yourself because of your body.

    I think that’s the disconnect. When we say people shouldn’t be happy with themselves if they’re fat it implies that being happy with one’s self is tied to the shape of one’s body. That’s the issue that body positivity aims to correct- the idea that the shape of your body determines your worth or lovability.

    Now, I do agree that “healthy at any size” just isn’t true at a certain point- whether over or under weight. That said, I am overweight, but I can run a mile, which I would say many people my age who appear to be healthier than I am or in better shape cannot do. My blood pressure is a slight issue, but it has been since before I had children and put some weight on. It’s hereditary, and I am otherwise healthy- cholesterol, blood sugar, etc is all normal. I’ll be 40 in May.
    All that being the case, should I feel badly about myself because I’m a size 14?Report

  8. Stephanie says:

    Size 14 is meaningless if we don’t know your height. Are you 5’7″ or 5’2″? Whether or not this is healthy for you is something between you and your healthcare provider. On the BMI chart are you in the “overweight” or “obese” range? I’d say “overweight” is like a yellow traffic light and “obese” means, “do something about it if you’d like to reduce your risk of preventable health problems.” But it’s no one’s business but yours.Report

    • Em Carpenter in reply to Stephanie says:

      I’m 5’5.
      So, should I hate myself or feel badly about myself?
      If so, what size do I have to be before I am allowed to like myself?Report

    • Maribou in reply to Stephanie says:

      @stephanie I think Em’s whole point here is that the body-positivity movement – the healthy part of it – is not about “Am I healthy?” it’s about “Am I allowed to love my whole self regardless of whether I’m healthy?” Not *despite* not being healthy. *Regardless*. (FWIW it grew out of the disability activism movement, so you can probably draw the parallels.)

      That is an important, worthy goal, for men and women. And one that is incredibly challenging for many folks to achieve.

      Responding to that question with weight analysis and disclaimers very precisely illustrates what I think you are missing about talking to people about weight.Report

      • Maribou in reply to Maribou says:

        As for the health part, the idea is to *uncouple* weight freak outs from whether one is healthy or not. It doesn’t say “It’s better to be fat” it says “healthy at every size”. Focus on improving your health, not on decreasing your weight. For providers, if there’s no obvious reason to pick weight as the first thing to try and fix – TRY TO FIX THE OTHER STUFF and focus on overall health, not the number on the scale. (Most doctors go for the weight first, or perhaps right after excessive smoking.)

        Agreed that some folks take it in a weird and problematic direction, but … people do that with literally everything. Weird HAES people are no more common than weird anything else, and wayyyyyyyyyyyyy less common than dangerously underinformed doctors and medical professionals counseling people about obesity.Report

  9. Stephanie says:

    How about: set a goal, make some minor changes to your eating habits, allow for slow weight loss, and don’t connect it to your self image. Just feel frustrated that you are not going to be able to achieve quick change, as anyone would.

    I don’t get where the “like myself” part has anything to do with your personal appearance. Think of the people coming out of wars with no facial features, or with missing limbs or other disfigurement. Does it make to sense to expect them to dislike themselves?

    Since the idea of disliking yourself about your weight is something you’ve talked yourself into, it makes sense that you could also talk yourself out of it. And without blaming society or Barbie dolls or TV or something “out there.” Learn to be kind to yourself.Report

    • Maribou in reply to Stephanie says:

      @stephanie Disliking yourself is the societal message (a strong one) that stuff like body positivity is designed *to combat*. Society is swamping people with reasons to dislike themselves for being fat.

      And, yes, for being disabled, whether physically or otherwise. Society swamps people with the message that they should dislike themselves for that too. It’s a major factor in the mental health struggles of both veterans who’ve acquired disabilities in combat and many other disabled people.

      Em has not *talked herself into* those messages, nor does who talked her into it have anything to do with whether she can talk herself out of it.

      The more you respond defensively and dismissively, the less credibility your “however diplomatic” framing above has.Report

      • Stephanie in reply to Maribou says:

        It looks like it all comes down to: if you allow yourself to be controlled by what you see as society’s attitude, you are giving way too much importance to pop culture and other stuff you could choose to ignore. Nothing is stopping you from accepting yourself regardless of what your physical shell looks like. On the other hand, if you are objectively overweight, you can decide to stay that way or not. Either way, I have no emotional stake in the matter.

        I looked at the BMI article and it’s irrelevant as it has to do with percent body fat calculation. We don’t need fat percent/body composition numbers to know if someone is overweight. Any given individual’s fat distribution is pretty obvious. Of course, any health professional is capable of sorting out which people are lean and which people are fat.

        You may call it “dismissive” but it’s certainly not defensive. I am able to DEFEND my point of view. There’s a difference.

        Some things you just can’t learn from the internet. Information and knowledge are not the same thing.

        This is starting to remind me unpleasantly of people with high school educations telling me how they learned on the internet that vaccines are bad and that they knew more about the subject than I did. So I’m exiting this discussion.Report

        • Maribou in reply to Stephanie says:

          @stephanie The BMI article is not irrelevant, and neither is the CDC’s caution.

          Please feel free to come back and comment any time, but if you want to tell me that the impact of society on people’s opinions of themselves is nil, the peer-reviewed review article that I put in front of you as a *start* when I was pretty busy reduces to one small aspect of what it says, that my biology degree and master’s in librarianship reduce to the equivalent of being an anti-vaccer when it comes to matters of human physiology and scientific research, and that you can tell if people need your now-very-questionable health advice based on looking at them….

          I’m going to continue to be very very skeptical that your credentials as a medical health professional (of unspecified type) give you any kind of authority on this topic.

          We cover a lot of topics around here though, and perhaps you’ll be less disgusted by your interlocutors in some other context.Report

    • Em Carpenter in reply to Stephanie says:

      The point: you have missed it.Report