I am often struck by a particular issue in public health messaging wherein there are two sides of an issue but we ignore one of them in order to reinforce cultural stereotypes about health and weight.
For example, almost everyone knows someone who eats a ton of food and never gains weight. Although that person may be treated poorly (which isn’t cool at all) we tend to accept that this is a phenomenon that can happen. Yet if a fat person says that they eat a reasonable amount of food but don’t lose weight everyone starts yelling “THERMODYNAMICS! YOU ARE A BIG FAT LYING LIAR!” If we accept that some people eat a lot of stay thin, then we have to accept that some people eat a little and stay fat. Of course how much someone eats, why they eat it, and what size they are is nobody’s business but the fact that society only accepts one side of this equation is very troubling.
Another dangerous example is the belief that the only way to increase mobility is to lose weight. We believe that people will move better with less weight and the same amount or less muscle (because muscle may well be lost in the weight loss process,) but we don’t accept that people can move better at the same weight with more muscle. Considering that the vast majority of people who attempt intentional weight loss end up fatter, this is highly problematic since the most common outcome of the mobility intervention is most likely to have the exact opposite of the intended effect.
Peter Muennig’s work from Columbia found that “Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms.” He also found that “The difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health.”
But those of us who suggest that liking and appreciating our bodies is the first step to health (knowing that health is not entirely within our control, not a barometer for worthiness, and not up for public discussion), and that public health interventions that shame and stigmatize fat people may actually harm us, are shouted down by people who insist that shaming and stigmatizing fat people – convincing us to hate ourselves – is not only necessary, but laudable.
Currently our public health interventions are based on shaming and stigmatizing fat people, making fat people’s bodies the public’s business, and equating body size with health. This isn’t working, largely because shaming and stigmatizing fat people tends to work and so we believe that our bodies are not worthy of care, and because weight and health are two different things.
On the other side are Size Acceptance and Health at Every Size which insist that basic human respect and the rights to life, liberty and the pursuit of happiness are, in fact, inalienable and not size, health, or healthy habit dependent. They also suggest that liking and appreciating ourselves gives us the best platform for making decisions about health and self-care, and that, if health is a priority for us, healthy habits are our best chance for our healthiest body (though of course there are no guarantees.) I’ve looked, and lived, at both sides and now and I am so happy that I did. This side is better by leagues and I’ll never go back.
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