I got the following e-mail today:
This whole Health at Every Size thing is nothing more than fat people justifying being fat and being too lazy to diet. It simply makes no sense in any other context.
Setting aside the fact that my body needs no justification, I came to a Health at Every Size practice based on the evidence. This person is confused – based on the research dieting is the thing that makes no sense.
Before we get too far into this, just a reminder of the usual disclaimers: health is not an obligation, barometer of worthiness, entirely within our control, guaranteed under any circumstances, and not anybody else’s business unless we ask them. The right to be treated with basic human respect is not size, health, or “healthy habit” dependent by any definition thereof. Fat people have the right to exist in fat bodies without shame stigma, bullying and oppression and it doesn’t matter why we’re fat, what being fat means, or if we could (or want to) be thin. Fat people’s health is not your business unless they ask you to make it your business. Anyone wishing to make a hand-wringing “But my tax dollars blah blah blah” argument can head over to this post.
But since they asked, here are 11 reasons why I think a focus on health rather than weight makes way more sense for my personal health goals:
1. Simple Observation
We know that there are healthy fat people an unhealthy thin people so weight=health does not hold up to simple observation.
2. Thin people get all the health issues that are correlated with fatness
And since thin people get all of these health issues, then being thin is neither a sure cure nor a certain preventative. Further, since we treat thin people for these health issues we have treatment protocols that do not involve weight loss. Those same protocols could be used on fat people who have these health issues – so that we are treating the actual health issue and not just trying to change someone’s body size and hoping that health comes along for the ride.
3. Correlation does not equal causation
Just because a disease is correlated with being fat does not mean that it is caused by being fat. In some cases, sleep apnea for example, a condition is thought to cause weight gain, leading to a chicken and the egg problem. By focusing on the health problem instead of the weight we avoid this issue altogether.
4. Confirmation Bias
We seek evidence that confirms our existing beliefs. For example doctors test fat people earlier and more often for health issues thought to be correlated with being fat, thin people who have the symptoms of diseases that are correlated with being fat are often ignored because the doctors assume that thin people are “safe” from these diseases. If you have two groups and you test one earlier and more often for a set of health problems, and subsequently ignore the symptoms of those health problems in the second group, of course the first group is likely to have a higher diagnosis rate.
5. Third Factor
One of the reasons that correlation does not imply causation is because the two things could both be caused by a third factor. It’s entirely possible that a third factor is responsible for both body size and health issues, in which case weight loss attempts will do nothing to address the problem and may even exacerbate it.
6. The Wrong Measurements
When people set weight loss as a goal, they are typically assuming that along with that weight loss they’ll get a host of metabolic health benefits: good cholesterol, blood pressure, triglyceride and blood glucose numbers etc. So when, like 95% of people, they fail at weight loss they assume that they failed at all of the health outcomes as well. But studies show that this isn’t the case. Had they measured their metabolic health rather than their weight they are likely to have seen health increases, even without weight loss.
7. Confusing the standard of beauty with health
As a culture we tend to have a single standard of beauty (which is a whole other problem). Unfortunately it is all too easy to assume that this single standard of beauty is also the single standard of health. That is simply not true.
8. Human Diversity
We accept a huge amount of human diversity. Large variations in shapes and sizes of feet, hands, and noses, heights, hair colors etc. are all considered normal. And yet we expect healthy bodies to conform to a narrow height weight ratio or we consider them “abnormal” or “unhealthy”
9. The Dieting Effect
In studies dieting (particularly dieting young and/or repeatedly) predicts weight gain. So even if I bought into the idea that “fat” is “bad,” dieting is the last thing that I would do since the most likely outcome is that I would end up more fat than when I started (which was certainly my personal experience of dieting.)
10. The Unlikelihood of Weight Loss
In studies since 1959 weight loss has shown a success rate of only a tiny minority. Doctors are prescribing a intervention that almost never works (and has the opposite of the intended effect the majority of the time) to 60% of Americans. The diet industry makes 60 Billion dollars a year taking credit for their successes, and blaming their clients for their failures.
11. The likelihood of increased health
We know that health is multi-dimensional and not entirely within our control. That said, studies show that most people will get a health benefit from participating in healthy behaviors (movement, getting enough sleep, having a strong social network, getting enough food etc.). Studies also show that most of these people will not experience significant long term weight loss but, again, will increase their odds for health.
12: Bonus Reason:
This whole thing is based on the (completely untested) hypothesis that if you make fat people look like thin people, they will have the same health outcomes. For now, I’ll set aside the fact that when researchers claim to be studying health and body size they are actually study a bunch of things that they rarely talk about or even attempt to control for.
Research found that men with certain baldness patterns have a much higher risk of cardiac incidents. Additional research found that the baldness and cardiac incidents likely have the same root cause.
Thank goodness the weight loss people weren’t in charge of this or instead of the additional research and actual interventions, we’d have a government-sponsored War on Baldness and a sixty billion dollar industry telling men that they have to grow their hair back to be healthy and that if they don’t it’s their fault, accompanied by reporters whipping everyone into a frenzy with articles about how much bald men who get heart disease are costing society.
The bottom line here is that, even if a large body is a “risk factor” for health issues, it does not follow that manipulating the size of that body will change health or risk factors, and it may actually make it worse. Making one group of people look like another group of people to try to duplicate health outcomes is not solid science.
So there you go, 11 reasons (and a bonus reason!) why I choose to focus on health rather than body size manipulation. Your get to make choices for you, and your mileage may vary, but let’s not pretend that dieting is the only choice that “makes sense.”
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