I’m producing a show of Plus Size Performers from Los Angeles (details here) and moving this week, plus we’re taking care of a rescue puppy who is severely sick so today is going to be a repost based on a number of conversations that I’ve heard recently about how things should be different if someone is “really fat.”
Often I get comments that say something like “I mean it’s ok to be a little big, but what about people who weigh [some random amount of weight that seems really high to the commenter from 200 pounds to more than 1,000, and/or some life circumstance, illness, or disability that seems like a big issue to them], when people are REALLY fat surely weight loss, including drastic measures (like stomach amputation or an at home stomach pump) should be taken.” or “Studies show that very fat people tend to die younger, what do you say about that?”
Let me start by saying that I am a “REALLY fat person” based on the BMI scale. I am Class III – Super Obese, as fat as you can get on the BMI charts. When I first found that out, I ran to the mailbox for weeks hoping to receive my cape and secret decoder ring. I’m still waiting – it turns out that it doesn’t come with a secret identity but it does come with a bunch of shame, stigma, and concern trolling. I want my freaking cape, but I digress.
As far as studies that say that very fat people (Class II and Class III) die earlier, that’s not as cut and dried as it sounds. To clarify some things: this “class system” of obesity is based on BMI and its many, many problems. Class III Obesity is defined by the World Health Association as a BMI of 40 or above. To use me as an example – I am 5’4 so anything over 232 pounds makes me Class III Obese. I weigh about 300 lbs. if I weighed 67 pounds less or 3,000 pounds more, regardless of body composition or any actual measure of health, I would be in the same class in study’s conclusions about weight and health, lifespan etc. when they are based on BMI. This does not exactly smack of stringent science.
It also doesn’t take into account that there are health issues and medications that cause weight gain and may also shorten lifespan as a side effect, or treat illnesses that shorten lifespan. Nor does it take into account that many people who are super fat spent most of their lives dieting and, considering statistics on weight regain and the dangers of weight cycling (aka yo-yo dieting), it’s entirely possible that this lifetime of dieting is the source of their current size, their health problems, and a possibly shorter lifespan. It doesn’t consider the dangers of being under the stress of constant stigma and shame and how that can affect someone’s health (Peter Muennig out of Columbia found that women who were concerned with their weight had more physical and mental illness that those who were ok with their size, regardless of their size.).
It doesn’t take into account the difficulties super fats can have getting proper healthcare – doctors who don’t listen to a word we say and suggest stomach amputation as a cure for everything from strep throat to near-sightedness, the dangers of being put on drugs for health issues we don’t have based on the idea that we might get them someday (I once had a doctor try to prescribe blood pressure medication before having my blood pressure checked – it was 117/70), and other issues including not being able to get proper treatment because machines aren’t built to fit us. Then there are people who avoid healthcare because of the shaming, stigmatizing, bullying experiences they’ve had, the fact that medical students don’t practice on fat bodies in gross anatomy classes and the first time surgeons see the inside of a fat body it will likely be when that body belongs to a patient on their table, the fact that when we are sick, super fat people can be under-medicated because the amount of medication is based on someone much smaller, or over-medicated because the amount of a medication doesn’t necessarily depend on body weight etc. So acting like body size=early death and the only solution is thinness is a massive oversimplification.
I also think that the larger someone is, the higher the temptation to suggest that whatever issues they are dealing with would be solved if they were just smaller. In truth, neither how fat a person is, nor the abilities and disabilities they may live with, change the fact that weight loss almost never works. In fact, weight regain is the most common outcome of intentional weight loss attempts, so even if someone is arguing that high body weight is dangerous, the worst advice they could possibly give is to try to lose weight. In study after study after study weight loss has not been shown to be successful at changing body weight or making people healthier. In fact, the only thing that weight loss interventions are shown to be highly successful at is causing long term weight gain. Weight loss does not meet the criteria for evidence-based medicine, and a fatter patient doesn’t change that simple fact. So even if someone thought it would solve all health problems if everyone was thin, we don’t know how to get it done. But we could stop stigmatizing fat people, thereby solving many of the issues I talked about in the last paragraph, and we could do it today. We’ll never truly know how much healthier fat people could be without all the shame, stigma, bullying, and oppression until we end it.
As always, people are allowed to make whatever choices they want about their bodies and health. From my perspective a Health at Every Size approach makes the most sense regardless of size, health issues, or ability, based on the evidence – there are no guarantees and my health is never fully within my control but I think the evidence says that healthy habits give me the best chance to support my body.
To me, Health at Every Size is about each of us prioritizing health for ourselves and then, if we want to set goals, setting them based on health/habits rather than body size. And it’s about treating health issues with health interventions, not body size interventions. So no matter what I weigh, I would set my goals based on what I want to be able to do within the parameters of my body’s abilities and disabilities and my situation, and let my body weight do whatever my body weight does.
And no matter what I weigh, I would deal with any health issues using health interventions. Let’s say I developed joint issues. I would likely be told that weight loss would “cure” those issues. You know what else would “cure” them? Being able to fly – which is about as likely as losing weight, so I’ll start dieting to fix joint pain right after I jump off a roof and flap my arms really hard. Or I could insist on being treated for my joint issues using interventions that are shown to actually help joint issues. I know that those interventions exist because thin people get joint issues as well and they aren’t told to lose weight, but they are treated.
People of all sizes deserve to be treated with respect and those of us who are “really fat” are in no more need of concern trolling, stomach amputations, or at home stomach pumps than anyone else. Everyone deserves access to foods that they choose to eat, safe movement options that they enjoy if they want them, affordable evidence-based wellness care and a life free from bullying, stigma, and oppression. Yes, even if we’re REALLY fat.
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