Health at Every Size?

In what light does society view a binge-drinker? What about a Juul user? A tanning booth user? Someone who doesn’t use a seatbelt, or use sunscreen? Most notably – what about a “fat” person? 

Binge-drinking, Juuling, tanning, and other unhealthy behaviors are arguably normalized (and perhaps even culturally praised). People put their health at risk in several ways, but society is particularly hostile toward those who do so through overeating. Why?

Fat Shaming is Pervasive

The results of the Harvard Implicit Project, a two-decade-long (and ongoing) study evaluating implicit bias, evidences society’s prejudices against those who are overweight:

Another study found that 40% of Americans have faced weight-based teasing, unfair treatment, or discrimination – including in job applications and, unfortunately, Ph.D. program applications:

Why is fat-shaming so prevalent if Juul-shaming, no-sunscreen-shaming, binge-drink-shaming, and tanning-booth-shaming, to name a few, exist only minimally if at all? Why are we so focused on shaming one particular health risk – obesity – but not others? Unless fat-shamers are immaculately healthy themselves, judgements made are hypocritical. How do we combat weight-based discrimination and social stigma? One movement aiming to do so is called “Health at Every Size.”

Let’s break down Ms. Poretsky’s main arguments. Is what she’s saying valid? Do fat and thin truly “not matter?”

Combatting Fat-Shaming Through Health at Any Size

Ms. Poretsky discusses the fat-shaming she has battled since childhood, which she explains caused her self-esteem to become “scale-dependent.” These experiences understandably threatened her mental health. She explains that the Health at Every Size movement has helped her to “create mental health and peace… and to let go of judgments” through three primary initiatives: eat “intuitively” according to hunger and satiation cues, find pleasurable body movement (enjoyable workouts), and intend to love and accept your body. These three initiatives are both medically healthy and mentally uplifting – rendering them a fantastic way to combat weight stigma.

Her Claims About Health: Correct?

Though the initiatives Ms. Poretsky describes above are valuable, she makes some questionable health claims. She says that the following is a myth: “fat is unhealthy, weight loss is healthy.” She also says “yo-yo dieting,” or “weight cycling,” is unhealthy, particularly because the majority of people regain weight after dieting. Though partially valid, there are problems with the evidence she supplies to support her claims.

Although “weight-cycling” isn’t proven to be physiologically harmful, long, repeated periods of especially restrictive diets can result in nutrient deficiencies (if you’re not getting enough food in the first place, you’re likely to be lacking in vitamins as well). This may be avoided through proper supplementation. Ms. Poretsky could be referring to non-supplemented restrictive diets, and to the potentially adverse mental health effects of a restrictive attitude toward food – which would partially validate her claim. She says that the statement “weight loss is healthy” is a myth. It can be unhealthy. It is not inherently unhealthy, however, so long as one does not engage in dangerously restrictive dieting. Weight loss can mitigate the negative effects of obesity, which can render it a healthy decision if gone about properly.  

Her claim that fat is not unhealthy is partially flawed. To evidence this claim, she discusses the obesity paradox – the hypothesis that excess fat can sometimes have a medically beneficial effect. She names a few of the scenarios in which the obesity paradox is valid – for example, Intensive Care Unit patients and elderly people with higher body fat percentages have higher survival rates. If one falls ill, having excess reserves of energy in the form of fat can have a protective effect. The problem with Ms. Poretsky’s argument is that she fails to mention that the obesity paradox, as defined by medical professionals, does not apply to everyone. Instead, she uses the specific scenarios that the obesity paradox applies to to conclude that “fat and thin don’t matter” across the board. In reality, unless one is at risk for becoming dangerously sick or is elderly, the benefits of excess body fat does not apply.

Ms. Poretsky pinpoints a few studies that support the obesity paradox to support her argument without considering any studies that suggest obesity is dangerous – of which there is an abundance. Excess fat, especially when reaching levels of obesity, is proven to be risky time and time again throughout scientific literature (see links at the bottom of the article to view several). Obesity is related to heart disease, stroke, type two diabetes, joint weakness or failure, some cancers, gallbladder, liver, and kidney diseases, and increased risk of mortality. Obesity-related diseases cost the United States $190.2 billion per year – 21% of annual medical spending. The argument that fat is not unhealthy is flawed – it does not specify that fat can most definitely be unhealthy, depending on the amount that exists in excess. 

It’s important to note that the unhealthiness of excess fat does not render thin people inherently healthy. Those who are lean may also be putting their health at risk through their diet.

Implications – Is Health at Any Size Valid?

The claim that “fat and thin don’t matter” is only partially invalid; “fat” and “thin” do matter physiologically, according to scientific literature (and the National Institute of Health). However, “fat” and “thin” shouldn’t matter when it comes to how we treat each other as humans. If one experiences scale related self-esteem issues, like Ms. Poretsky for example, one may choose to prioritize his or her mental health by avoiding dieting or deliberate weight loss. The choice to sacrifice one’s own physical health, unless it harms others, is personal and should not constitute cause for discrimination. 

Let’s eradicate fat-shaming and promote body positivity through the scientifically valid portion of the Health at Any Size movement – the three initiatives that Ms. Poretsky suggests. Because most of us engage in at least some form of unhealthy activity, shaming those who are overweight is hypocritical. No one deserves discrimination due to the size of their body. But as we work to eliminate weight stigma, let’s remember to prevent the spread of misinformation.  

–Lana

Sources:

https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22029

https://implicit.harvard.edu/implicit/aboutus.html

https://jissn.biomedcentral.com/articles/10.1186/1550-2783-7-24

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359159/

7 thoughts on “Health at Every Size?

  1. Hi Lana,
    This is a very interesting and well-executed critical piece. As an overweight person myself, I have gone through several periods of weight fluctuation in my life. I have noticed in my own experience that when my weight is much closer to the recommended one for my age and height, people tend to treat me better than they do when I am heavier. Thankfully no one has been actively antagonistic toward me in my teenage and adult life, but I would receive more compliments and people would initiate conversation with me more often during those times when I was thinner.

    It certainly is hypocritical when someone who has health problems and addictions of their own mistreat those who are overweight. Although having excess fat is not necessarily healthy, everyone should be treated with a basic level of decency and respect regardless. There are very few situations in which mentioning someone’s weight is anything but rude. In addition, many overweight people diet and exercise regularly, so it is harmful for someone to assume they have “let themselves go,” so to speak. Great post!

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  2. Great post! This made me think about the YA novel “Dumplin'” and its Netflix movie adaptation in which a plus-sized teen whose mom was a beauty queen competes in a beauty pageant in her Texas hometown. The book was a New York Times bestseller and the movie did quite well with younger audiences. There is clearly an audience for these stories, and I feel like mainstream media about people who aren’t considered “skinny” is really valuable in combatting stigma. I think there are two big reasons why this particular thing is so stigmatized. First, it is physically obvious. Unlike alcoholism or another form of unhealthy behavior, being significantly overweight is difficult to hide from passing strangers. Secondly, there is a false perception that a person’s weight is entirely their fault. The truth is way more complex. Some people have naturally bigger bodies or retain weight differently than others. Lots of people find it really difficult to lose weight no matter how much they exercise or diet. These social factors can be at least partially impacted by more representation because people will be able to view strangers who are plus-sized with more compassion and understanding if they have a point of reference in fiction. Most Hollywood actors and actresses have a very specific body type, which doesn’t help the issue. Representation is everything!

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  3. Hi Lana!
    I think you did a really great job talking about this topic factually and without any outwardly opinionated statements. My favorite point was that almost everyone in the world engages in some sort of unhealthy activity, whether it’s alcohol and drugs, food, or sun protection. While I hope everyone can agree that fat shaming is inexcusable, it is still important to recognize the personal health risks obesity poses. However, as you stated, these health risks are only the business of the individual and possibly their doctor. I had never thought about the disparity between how we view different unhealthy behaviors. For example, in many cases, AA or rehab is the only accepted form of treatment for alcoholism. While almost everyone thinks of AA as an ideal fix, many studies show that it is not as affective as we once believed. I think it is increasingly important to be mindful of the health risks of unhealthy behavior but not to the point of shaming someone for their habits.

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  4. Hi Lana,

    I think you’ve presented a really interesting piece about two competing discourses that currently exist about weight loss in America. I remember growing up watching reality tv shows like The Biggest Loser, where obese contestants dropped hundreds of pounds over the span of a few months. A practice most of us now understand to be unrealistic, and unsustainable. On the opposite end of the spectrum, after the rise of Lizzo, I think that there has been a discourse used by some individuals that argues that an individual’s weight is a totally private matter, and positions discussions of obesity as incongruent with the belief that people should still be loved and validated regardless of their weight.

    My hope would be for a world that embraces body positivity, while also promoting best practices for people to live healthy lives, but I am doubtful that can occur. Because American culture has spent so long associating people’s weight with other positive or negative characteristics about their personality, depoliticizing discussions of size and weight loss would first require establishing that all bodies should be treated equally.

    – Brandon J

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  5. Hi Lana!
    Very interesting and valid points. It’s interesting and at times sad, like this one, how appearance affects how we are perceived and treated by others, especially by people who have no idea about the other’s life. That being said, though, like you point out, I also do not think it’s very healthy to say bodyweight does not matter at all because in the end, being overweight, or underweight for that matter, is not healthy in the long run. But more than an individual’s personal eating habits, I believe it is the overall food consumption culture in today’s world as well as socioeconomic status, which influences an individual’s ability to choose how to eat, specifically in the US, that is the root cause of this issue.

    -Deniz

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  6. Hi Lana,

    Thank you for this piece. Sadly enough, fatphobia is so pervasive in American culture that even young children parrot it through derogatory jokes, using the word “fat” as an insult. The advent of social media has probably exacerbated it as well, with influencers openly advertising instant weight loss teas and lollipops that imply true beauty lies only in one body type. Ironic, considering how around the 16th century, fat was seen as beautiful while thin was associated with poverty, disease, and old age. I think we can partially tie fatphobia to classism as well—currently in America, the general public links poverty with obesity (I don’t know whether or not that is statistically true).

    Conversely to what I previously said about social media, I do think social media also does have benefits in that it has increased the visibility of body positivity movements. With a more democratized media landscape, there is higher representation of different bodies, and as Audrey said, that can significantly affect societal attitudes.

    I must confess I have never heard of the Health at Any Size Movement, so I’m thankful you brought it to my attention. Are there any specific public policies they have helped push?

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  7. Hey Lana,

    This was a very interesting and compelling piece. I think it highlights how the conceptions of broader society shape the lives of individuals. A large amount of people’s body image is based on their genetics and socioeconomic status (access to foods and ability to exercise) two factors that one has little to no control over moment to moment. Despite this, society still forces a singular “thin” ideal that in many cases can be as harmful both biologically and psychologically as its physical opposite. I think society needs to reframe the issue of body image as not one of physical size but more fitness and health. Linking health to size in such a direct way is harmful so I appreciate the “health at every size” movement for trying to remove that stigma, but at the same time, it universalizes health. Health should be the ideal independent of size but obviously included in that, is the reality that higher fat percentages are correlated to higher rates of heart disease for example. I would instead advocate for health through both eating and exercise and not a conception of size.
    – Satya

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