It’s become popular in recent years to act as if “public health” means making fat people’s heath the public’s business, or at least that most public health messaging should include some kind of fat=bad element. When I talk to people who are healthcare providers they often insist that it’s impossible to talk about public health without talking about obesity. I disagree. I think that we can have a complete discussion of public health without ever discussing weight, and I think it would be far superior to what we are doing now.
There are times when a discussion about weight might be indicated – like if there are large fluctuations in weight without explanation, or if a prescription is dosed by weight. I don’t think there is any need to discuss weight in general public health messaging at all, but I get a lot of push-back on this.
Before I get too far into this, the usual disclaimers apply about health and size acceptance.
The first argument that I typically get is that weight loss makes people healthier and we need to get the word out. Since public health messaging needs to be evidence-based, there are a couple of problems with this. The first is that, based on the evidence that exists, there isn’t any reason to believe that more than a tiny fraction of people can achieve long term weight loss. And the fact that some people survive jumping out of a plan without a working parachute does not make “Don’t use a parachute” a responsible public health message. In fact, by far the most likely outcome of a weight loss attempt is weight gain so even if someone believes that being thinner will make people healthier, the fact that we don’t know how to get that done means that “lose weight” is not an appropriate public health message. Similarly, even though levitating would be help people with knee issues (since floating will take the pressure right off the knees) suggesting that people jump off their roof and flap their arms really hard isn’t an appropriate public health message because – much like weight loss – we have no evidence to suggest that it will work. And let’s remember that there’s only about a 5% greater chance of losing weight than of successfully levitating. Also, there is no study that shows that those who maintain weight loss long term are healthier than they would have been – the idea that losing weight makes you healthier long term is a hypothesis, not a conclusion.
Another common argument I get is that companies are specifically manufacturing processed food that manipulates our brains into always wanting more food and never being satisfied without giving us nutrition, and that it’s important to let people know that those foods exist and may promote obesity.
I think that you can tell people the truth about foods without tagging on the “fat bogey man” message, and that it would be both more ethical and more effective. Suggesting that part of the population should make choices in an effort not to look like another part of the population is highly problematic and creates an environment where people are encouraged to stereotype and shame others for how they look which isn’t super healthy for anyone. Also, there aren’t separate healthy and unhealthy foods for fat people and thin people. If someone believes that a food is not healthy, then it’s not healthy for anyone. It’s not as if highly processed chemically manipulative foods are healthier for people who can eat tons of it and not gain weight. I think that an effective public health message would be to let people know that companies are trying to manipulate their brain chemistry to make them buy more food, and let them decide if that’s ok with them, not tell them not to eat this food because it might put them into a class of people who are being actively stigmatized and oppressed, thereby reinforcing that stigma and oppression.
Finally is the notion that fat people aren’t aware that they are fat and/or aren’t concerned enough about being fat so we have to tell people to worry about their weight.
To this I can only ask “What in the hell are these people talking about?” All of this FAT IS BAD EVERYBODY PANIC public health messaging has done one thing well – it has successfully stigmatized fat bodies. Not only isn’t this supported by the evidence, it’s actually contraindicated by it. Peter Muennig from Columbia has 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.” The truth is that we will never know how much healthier fat people could be if we weren’t constantly shamed and stigmatized, until society stops shaming and stigmatizing us. So how about we roll the OMGDEATHFAT messaging back and try something else?
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