FAQs

Here are my answers to some frequently asked questions. (Remember that I can only answer from my perspective and I can’t speak for anyone else.) If you have a question that you would like me to answer, please feel free to leave it in the comments!

Isn’t being fat unhealthy?

No. Weight and health are two separate things – there are healthy and unhealthy people of all sizes.  Health is multi-dimensional, not entirely within our control, and not a barometer of worthiness. The confusion of weight and health does a disservice to fat people because people (often including doctors) think that they can look at us and determine our health, it also does a dangerous disservice to thin people who are told that they are healthy simply because of their weight and that isn’t what the evidence shows. In fact, the evidence shows that people’s habits are a much better determinant of health than their size is.  Body size is not a diagnosis.  I call this a Galileo issue – “everybody knew” that the sun revolved around the Earth and so Galileo’s statement that the evidence showed that the Earth revolved around the sun was considered heresy.  Now “everybody knows” that fat is unhealthy and so statements to the contrary, even though they are fully supported by evidence, are considered heresy. That doesn’t make them any less true.  Even if fat was unhealthy, there are plenty of things that people do to prioritize their health that we don’t police (not getting enough sleep, not looking both ways before crossing the street, extreme sports etc.)  The idea that public health means making fat people’s health the public’s business is just thinly veiled fat bigotry.  Kate Harding has a fantastic post about this as well.

Isn’t Health at Every Size just giving up?

Health at Every Size is a choice to focus on healthy habits as a path to health rather than focusing on changing body size as a path to health.  Studies on long term dieting show that the vast majority of people regain their weight after 5 years, many regaining more weight than they lost – dieting does not meet the criteria for evidence based healthcare.  To me Health at Every Size is about opting out of a social construct, perpetuated by a 60 Billion dollar a year diet industry, that takes our money to solve a problem that nobody has proven is valid with a solution that nobody has proven is effective or even possible for most people.  Health at Every Size does involve giving up on some things, including the hope of getting the societal approval that comes with being thin.  But the cure for social stigma isn’t weight loss, the cure for social stigma is ending social stigma.  Health is a very personal thing – each person gets to choose how highly they want to prioritize their health and the path that they take to get there, and there are no guarantees.  For me it’s about the best I can do with the amazing and unique body I have which just happens to be a fat body.

How is it fair that my tax dollars pay for the healthcare of fat people?

Tax dollars pay for all kinds of things and unless someone has a list of everything that their tax dollars pay for broken down by what they do and do not want to pay for, then this is just about prejudice against fat people.  This is also a very slippery slope – should those of us who don’t drink get to opt out of our tax dollars paying for any alcohol-related health problems? Should vegans get to opt out of their tax dollars paying for the healthcare of non-vegans?  Should people who choose the Atkins diet get to opt out of their tax dollars paying for health problems of people who don’t eat low carb?  This whole argument collapes under even a bit of scrutiny.  Also, just to bring some facts to the table, the Congressional Budget Office, and anyone who has actually looked at the number,s has concluded that fat people are barely a blip on the healthcare cost radar.

How can you say it’s ok to be fat?

Because nobody needs anyone else’s permission or approval to live in, and be happy with, their body.  Fat people have the right to life, liberty and the pursuit of happiness and that includes the right to live life in the bodies we have without our government waging war on us or having other people tell us that we need to do what they think we should do in the hopes that we will look the way they think we should look. It is absolutely, positively, completely ok to be fat.

“I lost weight and feel much better for it. Why do you believe the two cannot be correlated?”

They absolutely can be correlated (which just means that they happen at the same time).  They might even be causally related (which means that losing weight might have made you feel better).  What I am saying is that this may be more complicated than weight less = feel better.  First is the fact that losing weight affords someone a ton of societal approval because thin is valued in this society.  Suggesting that stigmatized people solve social stigma by changing themselves is working the wrong end of the problem.  Also, all of the research that exists suggests that almost everyone who loses weight will gain all of it back (often more weight than they lost) and then they also feel worse about themselves than when they started out.  Finally, the weight loss and the feeling better may both be side effects of behavior changes and so crediting the weight loss is not just wrong, but may lead to sadness if, like most people, you regain your lost weight.

“I am a paramedic. One of my colleagues suffered a permanent disability after trying to lift a very obese patient off the floor. What do you suggest paramedics do with very heavy patients when we cannot be sure of lifting them without injuring ourselves? What would the ethical solution be?”

Paramedics put themselves in danger in many ways – communicable diseases, dangerous areas, etc.  and the ethical thing is to find out how to minimize these dangers while still doing their job.  In this case I would suggest that something like these forearm forklifts become standard issues for all paramedics. I think that this issue is about paramedics and people of size vs a problem, not paramedics vs. people of size.

“Doctors will generally prefer a non-invasive, proactive approach to health concerns where possible. Why should a doctor not suggest weight loss through healthy eating and exercise if s/he honestly believes, as a medical professional, that it may help the ailment?”

A doctor’s honest belief is not the standard for an ethical medical intervention.  In order for an intervention to be medically ethical it must be evidence-based – which means that we have to have a reason to believe that the intervention will work, and that it will not cause more harm than good.  Weight loss does not meet these criteria – there is not a single study where more than a tiny fraction of people have succeeded at weight loss long term, and there is no study that shows that people who lose weight live longer or become healthier. Prescribing weight loss for health is like prescribing learning to fly for knee pain.  Even though a doctor may honestly believe that flying would take the pressure off the knee, we have not reason to believe that it’s possible and therefore it is not an ethical intervention to prescribe. Further, evidence says that most people who lose weight will gain it back and that there are dangers to weight cycling (yo-yo dieting) and so it’s possible that the doctor’s prescription will do more harm than good.

“Designing, cutting, creating, costing and selling plus size clothing is a complicated issue (there are matters such as fabric waste when a correspondingly small size cannot be cut for a plus size one or a company does not believe it will sell a size 4 for every size 22, there are issues with scaling past a certain range within a size run and so on). Why do so many people not accept that when companies decide what sizes they want to create and sell, it is simply a business decision?”

Because we recognize that it’s not simply a business decision, businesses do not operate in a vacuum.   Those making the choices about clothes are often making them from a severe anti-fat bias.  Designer Karl Lagerfeld has said “No one wants to see curvy women,” “What do you want me to do – design clothes for fat people?” and “The body has to be impeccable. If it’s not, buy small sizes and eat less food.” Old Navy makes a plus line but doesn’t sell it in stores – is that because they don’t want their stores populated by fat people?  When Lane Bryant had very few 26/28 sized clothes I was told by a clerk that they wanted to be more “boutique” and so they were taking their larger sizes online only.

Also remember that sizing can be very arbitrary, a 12 in one brand is a 16 in another and though they are both the same amount of fabric, one will be charged as a straight size and one as a plus size.  We are told constantly that over 6o% of Americans are fat and stores still believe that they will sell more size 4’s than size 22’s – why is that?  Are we being lied to about how many people are fat?  Is it because the way that society treats fat women leads to them not believing that they deserve nice clothes, or believing that they should buy smaller sizes to be “aspirational”.  Does the fact that fat women are paid less than their thin counterparts lead to them having smaller clothing budgets?  This is indeed a complicated issue and it is more complicated than fabric wasting.

When business decisions are driven by bigotry it’s something that I think we should look at.

“I hear a lot of complaints that plus size clothing isn’t as cheap as the very cheapest straight size clothing. The influx of very cheap straight sized clothing in recent years is largely a result of sweatshops in the developing world with questionable ethical practices. If we are really concerned about protecting the oppressed and vulnerable, should we not be more worried about the pay and work conditions that get us dresses for £5 from Bangladesh than the fact that these dresses have a limited size run?”

I think that this kind of false dichotomy is quite derailing. If we operated this way no activism would ever get done because we would spend all of our time trying to figure out what the single “most important” thing to work on is.   We can, and I believe should,  fight for fair labor standards and fight for fair clothing standards.  And, to be clear, it’s not just that plus size clothing isn’t as cheap as the very cheapest, it’s often more expensive than the most expensive straight size clothing – and it’s made of cheaper fabrics with lower quality construction. (A plain plus-size camisole top is often same price as a straight size maxi dress for example.)

“I lost weight and kept it off for over five years. It has indeed required a degree of discipline and self control but I am not disordered or mentally unwell. Why does Kate Harding consider me a ‘freak of nature’?”

I am a great fan of Kate Harding but I won’t speak for her.  The technical term for what you are is a statistical anomaly.  It’s a fact and there is no judgment in it – it just means that your experience is atypical based on the research that exists.  There are people who lose weight and keep it off for more than five years, just like there are people who survive skydiving accidents even though their parachutes don’t open.  The fact that a tiny percentage of people people survive does not mean that we suggest that everybody should ditch their parachute, anymore than the fact that a tiny percentage of people maintain weight loss means that we should suggest that everyone try it.  The vast majority of people who attempt long term weight loss gain their weight back, and a majority of those gain back more than they lost.  When most people trying an intervention have the exact opposite effect, ethically we have to stop recommending it, at least until we figure out why and have research that shows a higher degree of success.

“Exactly how large/strong should clothing/seats etc be made, given that they will have to be somehow finite and it will always be theoretically possible for someone to exceed their limits?”

This is a complicated question – with seats I think that the best idea is to make our best effort – armless chairs, armrests that raise and bench style seating all accommodate a variety of sizes.

With clothes I think it’s about making sure business aren’t making decisions based on bigotry and having some businesses that truly want to figure out how to serve people of all sizes with affordable, well made, clothes in a variety of styles.

“If buying two seats on the plane is not the solution, what should airlines do to ensure that everyone who paid for a seat is able to be comfortable and safely accommodated?”

They could create an ordering system where you can buy a second seat in a way that zeroes out the total for the second seat.  They could have a way for fat flyers to register and by noted in their system, they could have a number that fat flyers could call to let them know about the need for a second seat.

Remember in addition to any of the comments you might have, if you have questions that you would like me to answer, you can leave them in the comments as well!

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