I heard something today that I can barely even comprehend. Reader Lisa told me that her husband went to the doctor because he had been exposed to the potentially fatal Hantavirus at work and was starting to show symptoms. As the doctor started the exam, he patted her husband’s stomach and called it a “grocery tumor”.
This is egregious, it’s unbelievable, it activates my face punch reflex, and it’s also exactly what we can expect when we constantly and consistently conflate weight and health as we do in our society.
We have convinced our society that we can take a ratio of someone’s weight and height (BMI), or hell – just look at them fully clothed – and make determinations about their health, their cost to society, their habits, their worthiness, their morality and any number of things that helpful people on the internet love to tell fat people about us.
It’s absolutely wrong for several reasons:
Body Mass Index (BMI): You may have heard that it’s not a good measure of health. That’s not true. The truth is that it’s not a measure of health at all – it’s a simple ratio of weight and height. If you know someone’s BMI then you know…wait for it…the ratio of someone’s weight and height. It doesn’t tell you anything about body composition, habits, or actual health measurements. Body size, regardless of how it’s measured, can tell you a maximum of two things: 1. What size someone’s body size is and 2. What your prejudices about that body size are.
It also doesn’t make sense from an evidence perspective – there is not a single study where the majority of participants have moved from “overweight” and “obese” to “normal” weight, maintained it for five years and seen health benefits. The idea that weight loss is possible for most people is completely unproven – and disproven by the evidence that does exist - and the idea that if that weight loss happened it would make people healthier is also no more than a guess. Meanwhile, plenty of evidence shows us that habits are a much better determinant of health than is body size.
And it leads to some horrible things. Like doctors diagnosing fat people as fat and prescribing weight loss while ignoring any actual symptoms they are having and giving them an entirely different treatment protocol than they would give a thin person with the same ailment. Or a so-called medical professional calling someone’s stomach a grocery tumor. Or people making a full-time hobby out of going on the internet blaming fat people for everything that they can think of. And on and on until we have a society that is so rife with size stigma and bullying that fat people spend all of their time trying to hate themselves thin and thin people spend their time trying to hate themselves not fat, while our lives fly by and our bodies go completely unappreciated for what they do, as we risk our health for thinness instead of caring for our bodies and letting them settle into the same beautiful diversity of sizes that we see all throughout nature.
The saddest thing is that we could end all of this tomorrow with one simple step. We have to take a crowbar and separate weight and health permanently. Take weight out of the health discussion completely. Give people of all sizes the same treatment protocol for the same health issues. Immediately cease any and all health messaging that could create shame, poor body image, or stigma. End all messaging that seeks to make people feel guilty for their choices or bad about their bodies. Start giving people information and true access – to the foods they want to eat, safe movement options they enjoy, and affordable healthcare.
We need to be clear that health is a very personal thing and that people get to prioritize their health and choose their path, and that the job of public health promotion is to give people information and options and then allow them to make their own choices without shame or stigma. Just look around and you’ll see the result of conflating weight and health - unhealthy relationships with food and exercise, people who think that their bodies are unworthy and therefore unworthy of being cared for, eating disorders, people trying to hate themselves healthy and failing everyday. Newsflash: It’s. Not. Working. We must now perform the most noble act of science: admit that we’ve been very wrong and declare that we’re going to move ahead on a different path. We are never too far down the wrong road to turn back and the sooner the better.
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