On fat acceptance

I've read various blogs and articles on fat acceptance before, during, and after my weight-loss process. I agree with much of what they have to say, but I feel like writers are often so pained by their individual experiences of prejudice that they are too vehement, too general, and obscure some important points.

I agree with FA that all people deserve to be treated with human dignity and respect, regardless of their size, and for that matter, regardless of why they are the size they are. Even people who do nothing but eat Pop-Tarts and pizza in front of the TV all day deserve decent treatment - and possibly emotional counseling, but that's beside the point.

I agree with FA that BMI is a crude and often inaccurate indicator of appropriate weight. I mean, in the first place it doesn't even make dimensional sense. You take your weight, and you divide by... the SQUARE of your height? Prescribing the same BMI range for everyone basically suggests that your weight should be proportional to your surface area. If it were the cube of height, then it would at least give units of body density, but that's not the case, and that's why plenty of short "underweight" people are fine and most healthy tall people are high-normal to overweight.

I agree that obesity is not a disease, it is at most an indicator, and one that is neither specific nor sensitive. Not everyone who is sedentary and eats crap becomes fat, and fat can be a result of not just run-of-the-mill bad lifestyle but also leptin imbalance, binge eating disorder, PCOS, side effects of medication, or a nonpathological high setpoint.

But then there's something like Katy Harding's "BMI Project." It's not a bad concept. Lots of women, a few men, and one cat of various BMIs pose and their BMI-based category is displayed. The point is to show that BMI is absurd, and... it sort of does. Most of the "underweight" people look just as normal as the "normal" people, and so do many of the "overweight" people. Some of the "overweight" people do look overweight, and most of the "obese" people do, though I wouldn't have guessed a lot of them were in the obese category, and in some cases it's obvious all the weight is in the boobs. What starts to bug me is in the comments, where everyone glees over the fact that all these people look amazing, and suggest that BMI of 20-40 should be considered "normal".

BMI has its flaws, but a BMI of 40 is not a good sign for most people. There are, in fact, statistics on mortality rates associated with BMI, and there is a U-shaped curve bottoming out around 25-27. Considering this is the low-overweight range, this is one of the most solid reasons to criticize BMI, but a BMI of 40 carries a statistical mortality risk roughly equal to a significantly underweight person. Of course, in both cases there is wide variability. Some underweight people are anorexic and at very high risk of heart attacks and infections for common-cause reasons, while others are simply light people, but they still will have a lot of trouble if they get too sick to eat for some time, and will be more likely have low bone density, because these are direct consequences of low weight. Some obese people eat junk food on the couch all day and are at very high risk of cardiovascular disease and diabetes for common-cause reasons, while others are simply heavy people, but still are more likely to have sleep apnea, joint, and back problems, because these are direct consequences of high weight.

Then there's the other part of her site where she insists that diets don't work, even if you "don't call them diets", and basically suggests that losing weight is hopeless and unreasonable, and if you think it worked, get back to her in 5 years, and if you've kept it off that long, you're a freak of nature. Part of what rankles me about this statement is that she effectively says, if you are exception to my rule, then you must be so exceptional I don't have to take you seriously. The other thing is that diets do work for the initial phase. Even stupid diets will make you lose weight. Better diets will make you lose fat. And thoughtfully considered weight-loss plans will make you lose a significant amount of fat without feeling deprived, provided your body is okay with it.

Where diets "don't work" is in keeping off the weight. And basically what this says is that diets don't work if you don't stick to them. Lifestyle changes don't work if you don't stick to them. But this is not news. Nothing, in any area of life, works if you don't keep doing it. So the question is not whether weight loss strategies work but why people don't stick to the plan to maintain. Katy's answer to that question is set-point: people's bodies drag them back to their previous high weight. That's probably the case for some people. But it's not the case for all people. Some people successfully lose weight and keep most or all of it off. Some people simply go back to crappy habits, and in that case it's a failure of discipline. Please note that I don't attach any moral judgment to that; often our "discipline" is highly mediated by situational factors. It's easy to go back to Pop-Tarts for breakfast, McDonald's for lunch, frozen dinner from a box, and a cascade of coffee with cream all day if you are poor, busy, stressed, and easily hooked on sugar. It's also easy to simply add a chocolate bar every day as a stress reliever to an otherwise healthy diet and gain 20 pounds. My point is that people's bodies aren't driving the weight gain in those cases; it's a constellation of mental and social forces that may have little to do with their body's ideal weight.

Fitness, and the actual presence of health problems or more immediate risk factors are fair distinguishing factors. Fat people who are strong, enjoy exercise, have healthy blood pressure and good insulin control, and don't have any chronic health issues, are likely to be in the set-point category. Fat people who have high blood pressure, experience sugar cravings, and can't jog for 5 minutes are likely to be in the bad-habits category. One comment in the BMI project thread I think was spot on: "whatever the category associated with the lowest mortality – there is NO evidence that becoming fatter (if you’re under that “ideal” weight) or thinner (if you’re over it) causes you to acquire the health characteristics of those who are naturally at that weight." What I think needs to be added is that not everyone "naturally" approaches their own "ideal weight." Some bodies are particularly susceptible to harmful environmental influences. It seems like FA advocates hate when people bring up the fact that the population as a whole is becoming heavier, but it is a clear indication that not all obesity is due to genetics. It's changing too fast for that to be the case. I agree with FA that not all fat people should lose weight, but I disagree that anyone who has difficulty losing weight or keeping it off should not be trying to do so.


It's difficult to discuss, I know, because so many fat people have been subjected to harmful discrimination or frankly inhumane treatment solely on the basis of their weight. Yet some fat people do need to lose weight. Some fat people with clearly fat-related health problems are ignorant or in denial and need to be motivated to change their lifestyle more than they need to be told to accept themselves (although this can become tricky when shame or self-esteem issues are connected with not taking care of one's body). Most importantly, it is unhelpful to people who would benefit from losing weight and want to, to be told that it's a hopeless enterprise and they should just accept themselves the way they are. 


To sum up: we all have different bodies. Some of us have thin bodies, hard and lean bodies, fat and squishy bodies. Some of us have dark-skinned bodies or light-skinned bodies. Some of us have male bodies, or female bodies. Each type has advantages and disadvantages relative to other types. Fat people are statistically more likely to get Type 2 diabetes? So are black people, but people aren't told to change their skin color from black to white, and even if they did, we wouldn't expect it to affect the underlying mechanisms that give rise to that risk. On the other hand, white people who become significantly darker through suntanning are legitimately told that they shouldn't get so much sun because they're increasing their risk of skin cancer. Some people deviate from their "natural" body type for such reasons, and that can introduce unnecessary health risks. We should all seek to find our personal ideal weight, because that's probably the best bet for minimizing our own risk. We are stuck with the particular set of good and bad proclivities that our genetics handed to us, but we can avoid extra problems by not straining our bodies in directions they're not designed to handle. That means everyone should eat a healthy diet, get regular exercise, and engage in meaningful social activity. It means some fat people (like many featured in the BMI slideshow) are gorgeous, curvy, triple-D-cup women who should stay that way, while others (like myself at a BMI of 30) need to lose a lot of inches off a lot of places and will feel better when they do. We may still have trouble keeping off the weight, but if we feel more energetic, have a better mood, look more shapely, and enjoy the things we can do with our light bodies, then what we need is not exhortation to accept being fat but support in fending off the deleterious environmental influences that are making us fat against our body's natural inclination. Similar comments apply to thinness, and other dimensions of body type.