One of the questions that fat acceptance advocates get asked a lot is: what about your health? How can you be healthy, being so fat? How can you accept your fat if it’s making you unhealthy? These questions are based on some misunderstandings, for sure, but the answers to them are complicated.
Please note that I talk about “size” acceptance rather than “fat acceptance” because even if skinny women are treated as more desirable sex objects than fat women, the umbrella problem hanging over all this is that we’re all being judged mercilessly every day on our desirability as sex objects. 500 years ago, fat women may have been considered more desirable, but that doesn’t mean things were better for us then.
The numbers that matter
In determining the quality of your health, weight is one number that doesn’t matter. The numbers that do matter include your good (HDL) cholesterol, bad (LDL) cholesterol and triglyceride ratios, and your blood sugar, among many others. If a doctor tells you that you should lose a few pounds, ask her why – which numbers are off? If she shrugs and says they’re all fine, but it’s just a good idea to lose weight, you’ve got a doctor who’s been brainwashed into thinking “fat=bad.” It’s not that simple, and someone with several advanced degrees in the health field has no business not knowing that.
[ETA: BMI, the way many insurance providers and health practitioners apply it, is a load of bullshit, too. The link goes into great detail on why it's "mathematical snake oil."]
Fat doesn’t cause disease…
There is actually no evidence that being fat will give you diabetes or cancer or PCOS or any other health issues. Being obese tends to correlate with some health problems, but the causes of the health problems may be multiple, and they certainly aren’t thoroughly understood in current medical research.
It must be pointed out that many obese people are perfectly healthy, if you look at the numbers that matter. This seems to refute the idea that fat alone causes artery clogging, diabetes, or anything else it’s often blamed for – clearly, there are at least other factors besides fat, and it may even be the case that fat’s nothing to do with it at all. As long as your other numbers are good, your weight does not impact your health. If you can possibly afford to get your numbers tested once a year, or even every few years, do so. If the numbers that matter are good, your weight is fine.
…but the cures can involve weight loss
Regardless of your size, if the numbers that matter are not where they should be – if your bad cholesterol’s high and the good cholesterol is low, or the blood sugar is heading into pre-diabetic territory, or whatever – then you should make some diet and exercise changes to bring those numbers down. In the course of bringing them down, you may or may not lose weight. People in the underweight to barely overweight range can have bad cholesterol, blood sugar and other numbers that matter, and chances are the dietary changes they make will not cause them to lose significant weight. Also note: you can lose lots of weight without improving the numbers that matter. This may be the single most important fact to memorize: losing weight doesn’t solve anything. Taking steps to improve the numbers that matter, with weight loss as a possible side effect, can solve health problems.
If a diet is bringing the numbers that matter to where they should be, then it’s a good thing. Being on it doesn’t mean a failure to accept your size. Any weight loss incurred in correcting the numbers that matter is merely a side effect of the treatment for legitimate health problems.
Ignorant doctors
Doctors put a lot of overweight women right off getting physicals. Many, many doctors focus on weight to the exclusion of actual health problems that are staring them in the face. (They also tend to look at skinny women and erroneously assume all their numbers are where they should be.) These doctors need to go back to school for a few years, plain and simple. That we tolerate this ignorance in people we license as experts perhaps suggests something about why the United States is falling like the Roman Empire and will probably never recover. Don’t internalize other people’s foolishness (don’t read the comments).
I suggest telling a doctor right up front something like this: “I know there’s no proof that fat causes health problems. I don’t want you to tell me to lose weight. However, I do want you to tell me if my cholesterol, blood sugar or other reliable indicators of disease are off, and if they are, tell me what I need to change and I’ll change it. But if you focus on the weight, you’re not focusing on the right numbers.”
Doctors who promote weight loss for weight loss’ sake are not doing anyone any good, anymore than fashion designers are. Conversely, doctors who promote improved nutrition and exercise for the purpose of keeping the numbers that matter under control are doing it right. Diet and exercise are preferable to taking pills to control these brewing problems, because the pills can have far worse side effects than weight loss.
In conclusion
Basically, what I’m suggesting is that we learn to ignore numbers that don’t really matter – weight and size measurements – and learn to pay attention to the numbers that really are helping people live longer and prevent disease: cholesterol, blood sugar, etc. I have a family tree full of overweight and obese people with excellent cholesterol and blood sugar numbers who live to be well up in their nineties, and I’ve shared this fact with more than one boss who thought fat people were automatically costing his company more in insurance. It really sucks that we can’t get all the right people thinking this way right off the bat. But if we refuse to take seriously advice about what we “should” weigh, and instead insist on reframing that advice in terms of the numbers that matter, maybe we’ll influence one person at a time.
Maybe we’ll influence a doctor who will get curious, do more research, learn what I’ve learned (without his advanced degrees – ha) and start teaching all his patients the right way to look at their body numbers.
Maybe we’ll influence a boss who only wants to hire skinny people because he mistakenly thinks they won’t have long-term, chronic, expensive health problems but fat people will.
Human beings like visual solutions. It’s hard to get cholesterol numbers – there’s blood to be drawn, tests to be run, expenses – but it’s very easy to look at someone and judge them based on their size. The appeal of oversimplified answers must be fought with rolled eyes, logical refutations and perhaps, eventually, even the ostracization of people who insist on sticking with them. In short, society needs to start demanding that people think instead of encouraging them not to.
Size acceptance can and should incorporate concern about the other numbers that represent actual health issues. Despite correlations, weight and size measurements really don’t have anything to do with the numbers that matter. Separating them in your head can help you accept your size while still pursuing good health.
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Goldenblack,
I don’t know – that’s a little worrying.
BMI is so unreliable. Mine says I’m obese, but when an actual nurse tested me with a bioelectric impedance device – a thing you hold that shoots tiny currents through your body (it passes through fat differently than through muscle or bone), she came up with “marginally overweight.” This is because BMI has no idea how much muscle you or I have, not to mention breast tissue in women, and we are not all the same – not even close.
Even when I’m close to the low end of the lowest estimates for what my weight should be based on my height, my hips are “big” and my thighs are kind of thick, so people still think I’m just a little overweight. But when you touch my hip or thigh at that weight, you can tell it’s pure muscle and very little fat. *I* think it’s clear I’m just more muscular than average, and the BMI doesn’t get that.
Also, ladies? A breast can weigh up to about 12 pounds (that’s for really huge ones). That’s 24 pounds for a set. On this page, a woman whose breasts were weighed during a cancer screening procedure says her DDDs were 8.6 and 9.2 pounds. If most weight estimates assume a B-C cup, then I would guess my DDs are adding at least 5 pounds to my weight that really shouldn’t count?
And yet, has any doctor, any trainer, any nutritionist EVER suggested to any of you with big breasts that your ideal weight should be adjusted by the breast weight above and beyond whatever the estimates use?
Jennifer Kesler(Quote) (Reply)
Goldenblack, that sounds really weird to me.
I self-diagnosed my second pregnancy before taking the preggo test (because I was breastfeeding and taking a low-dose pill and I’d had only one breakthrough period, so I had no reason to suspect pregnancy) by observing that while I was using my BMI-testing scale, my BMI went really, really weird. I think it went absurdly low rather than high, but the point is, water weight does not have the electrical impedience that fat does, so if you’re using a BMI testing device and you’re pregnant, the results will MAKE NO SENSE. Because all the extra weight on a pregnant woman is either water weight or the actual weight of the baby — there’s relatively little added fat.
Monitoring the weight of a pregnant woman can make sense, if she’s at risk for certain disorders (which goes back to the OP’s points about the numbers; you never ask a pregnant woman to *lose* weight, that’s dangerous, so all you can do safely is watch the numbers, which is all you should be doing anyway), but monitoring her BMI? Makes no sense. Within the first month of a pregnancy you’ve taken on enough extra water that even though you can’t see it yet, your BMI electrical test will stop making sense.
Alara Rogers(Quote) (Reply)
Alara Rogers,
Wait a minute, I just realized I am talking about the electrical impedience measurement method Jennifer mentions above and not actual BMI.
Although that being said, BMI is obviously unreliable if the exact same height and weight produces wildly different electrical impedience effects depending on things like *pregnancy*.
Alara Rogers(Quote) (Reply)
I have had… a very strange relationship with my weight.
As a teenager my BMI would have been (according to the calculator I found on the NIH website) 18.3, technically underweight. I was a cross-country runner with a voracious appetite and irritable bowel syndrome (and anxiety and depression and a borderline mother…). Everyone always felt they had the right to comment about how skinny I was. Every. Damn. Day. School administrators, complete strangers, anyone and everyone felt perfectly fine saying, “Oh my god! You’re so skinny! How do you do it? Are you anorexic? Eat a sandwich!”
So there I was with the culturally-conditioned “good” body, and yet somehow I was still getting this constant criticism and overt discussion of my weight. I started responding with, “You wouldn’t tell a fat person, you’re so fat, so why do you think it’s appropriate to say, oh you’re so skinny??” Nobody had a good answer for that, and I was left with this constant flow of critical attention (and I HATE attention with every fiber of my being). I wore baggy clothes to hide my body and ate everything in sight in the hopes of looking “normal,” to no avail.
Suddenly, at the age of 23, I gained 30 pounds in the space of a year. My lifestyle hadn’t changed. My diet hadn’t changed. I was freaking out over this sudden weight gain with no apparent cause, and when I went to my doctor to have it checked she said, “Oh, you’re becoming a woman!”
Seriously, dude?
I never found an underlying cause for the weight gain. My cousin pointed out that all McCrary women seem to experience that same weight gain at roughly the same age (which still does NOT preclude an underlying medical cause). And now every time I go to the doctor she tells me that my BMI is in the overweight range and that I need to diet and exercise more, but she hasn’t checked any of my numbers for two years.
The funny part is, other than the bit of belly I have in front, I like the changes that the extra weight has made. My husband certainly likes them (as he’s not particularly attracted to twelve-year-old boys). I have curves and boobs now. People have stopped with their goddamn attention…. except that I lost 10 lbs this summer (archaeological excavations in the desert will do that) and school just started again so everyone’s all “OOh you lost weight!” and I’m all, “Yes, I had a lovely time in Jordan and the wedding was absolutely fabulous, thanks for asking.”
</biographical details
Megan(Quote) (Reply)
I feel kinda iffy about this side-comment. Maybe I don’t know anything being that I am and have been a “girthy American” since I hit puberty but isn’t that kinda insulting towards skinny/no-curves-having women, including your past self?
Just a thought.
Casey(Quote) (Reply)
Exactly! The electrical impedence thing is considered the most accurate way to measure body fat, and even it can’t make every distinction that needs to be made.
Megan,
Sorry for the attention, but I really want to jump up and down and point at your post, because the shit skinny women go through is not always obvious to the rest of us. Since we consider not looking like a 12 year old boy “fat” in this culture, there are far more women dealing with some degree (however ludicrous) of “fat” mistreatment, and it’s good to get reminders that “fat” isn’t the only unacceptable size. Women just can’t win. Ever. At any size.
It sounds like you’d benefit from finding another doctor who’s actually willing to check your other numbers to confirm there’s nothing wrong. I often gain weight without changing my habits whenever I’m especially stressed out… but I don’t think any doctor has ever believed that. They ALWAYS assume you’re overeating and don’t realize it. You may never be able to find out exactly why you gained that weight, but some basic annual bloodwork is a perfectly feasible request if you have health insurance. Most insurers will cover a “physical” once a year or so, and that should give you the numbers you need.
Also, I insist they give ME the numbers instead of just looking at them and saying, “You’re fine.” My current doctor prints them out on the spot, which is awesome.
Jennifer Kesler(Quote) (Reply)
Jennifer Kesler,
Ok, attention as a response to a post I made is fine. It’s when the cashier at McDonald’s hands me my McNuggets and then asks, “Are you bulimic?” that I start to twitch.
Don’t worry, I’ll be asking the doc for all my numbers next time I go (y’know, for something other than heinous horrible illness).
Casey,
I guess I’d refer you to Jennifer’s above response? I may have more to say later but so far today I have had insufficient caffeine to think properly. Or something.
Megan(Quote) (Reply)
Megan,
Yeah, I read Jennifer’s response and I know what she’s talking about (I do get what you were talking about as most of my friends are thin and are harassed/derided by others for being “too thin”…also most of said thin friends are WOC who usually get this treatment from friends/family who usually reprimand (whether it be through “good-natured” teasing or outright hostility/asshole-itude) for not being acceptably curvy enough, so there’s a whole ‘nother issue going on there.
Another anecdote I have is last term a woman in my math class leaned over to me and said (in what I felt was apropos of nothing) “I bet that bitch is anorexic” in reference to a tall, skinny (white) classmate who was talking to the teacher. >_>V
The whole “looking like a 12-year-old boy” thing just made me wince since it’s so often used against my thin friends as an insult, plus I see it used a lot to attack thin women by people who are into that “REAL WOMEN HAVE CURVES~!!1one” mindset, which really does nobody any good.
Sorry for the tangent.
Casey(Quote) (Reply)
Casey,
Ah, now I see. Thanks for the explanation (my autism’s been really bad the last couple days – long story). You’re absolutely right that it’s used as an insult. I think in this context I was using it in a self-deprecating manner in some twisted attempt to apologize for having been skinny? God, the way society’s bullcrap gets into our heads and makes our heads hurt is really… sucky. Leaving it there because yeah, the words, they are not speaking to me today.
Megan(Quote) (Reply)
I hate, hate, hate the “real women” phrase. It is exactly the kind of erasing, dehumanizing behavior that the people who use the term claim to be opposing.
“Real women don’t look like (celebrity X).” So she isn’t real? Or she isn’t a woman, or a person?
Patrick McGraw(Quote) (Reply)
Oh, not to worry! And I get the self-deprecation thing now. I used to use self-deprecation in reference to my weight, usually with slightly harsher language like “fat fuck”, “fat sack-of-shit” and “giant pant-load”…however I’ve been getting over my extreme self-loathing and now refer to myself as being fat as a neutral descriptor…which results in friends saying “ZOMG, YOU’RE NOT FAT, STOP SAYING THAT~~!” like I’m still insulting myself. *le sigh*
Casey(Quote) (Reply)
Patrick McGraw,
Ugh… I kinda hate convos like this because even though I agree with what you’re saying, I hate when ppl go the celebrity route in their explanation. We KNOW that celebrities are photoshopped to hell and back. So, no, REAL WOMEN (who come in all different sizes, have pores, joints that don’t bend like that, breasts that demonstrate the existence of gravity in a variety of ways, etc) DON’T look like the celebrities you see on magazines and TV shows, because they’re NOT PHOTOSHOPPED.
Maria(Quote) (Reply)
Maria,
You can be photoshoped on a TV show? Like…as the show’s airing…? 0.0
(I keed I keed, I think I get what you’re saying)
This is slightly OT, but this REAL WOMEN DERP DERP thing also reminds me of something that seriously has been raising my hackles…on Deviantart and whatnot I’ve been finding a lot of people who subscribe to the gender flipped version of that argument with “I LIKE MENZ WHO LOOK LIKE MENZ, LOLOLOL!” because skinny, androgynous bishounen are invalid as men I guess.
Casey(Quote) (Reply)
Because this culture thinks women’s bodies exist for people to judge, it’s really hard to say anything – including much-needed commentary – without sounding like you’re putting somebody down. I mean, if you say “I don’t like hairy guys”, you’re just stating a personal preference. But if you say, “I don’t like [women of one body type or another]“, it can turn into a political statement (and may well carry unconscious cultural baggage).
That said: the media CONSTRUCTS women. The women you see in media do not look like that when they’re at home and out of makeup. (Some male actors are JUST as gorgeous in person as they are on film, because aside from good lighting and a little foundation to even out skin tone, they’re allowed to appear on film pretty much how they look in real life. But even stunningly beautiful women are typically made up to the hilt before they’re good enough to appear on camera.)
“Real women have curves” was definitely a bad choice of words when it initially rang so true to those of us the media didn’t think existed for so long. But it turned out the skinny women weren’t feeling great about their bodies either, for the most part, because there’s just no satisfying a culture that thinks women need to be shaved, moisturized, dyed, made up and glossed before people won’t vomit from the site of them. So, as Maria said, “real women come in all shapes and sizes.”
I totally get what Megan was saying, but that’s not the only reason I didn’t say anything against the 12 yo boy remark. Yes, it’s certainly wrong to imply that there’s anything wrong with women who naturally have un-curvy figures, or with people who find that look attractive. BUT it also needs to be said that of all the things for the media to pick as the best body a woman can have… the body of a 12 yo boy? While I can’t bring myself to get all Freudian about an individual’s preferences – my own are very weird, and I have no clue where they came from, LOL – it kind of IS appropriate to ask some questions when an entire culture decides, “Women look best when they resemble children”… except, it seems, someone forgot to mention that to the people who are oriented toward women, because if anything, they seem to prefer curvy types as a whole. It’s a very weird dichotomy that needs to be examined.
And yet, what I just said could be taken as denigrating women who look like kids, and/or the people who find them sexy. It’s hard to find the words, when every comment anyone ever makes about a female body is so politically loaded because the culture has made it that way.
Jennifer Kesler(Quote) (Reply)
Jennifer Kesler,
Yeah, knee replacement and obesity don’t correlate. On one end of things there are your relatives, Jennifer, and on the other end there’s my grandfather, who’s always been thin/athletic, and has needed double knee replacements. I’m genetically predisposed to knee problems, and you most likely aren’t–weight has nothing to do with it.
Alyson(Quote) (Reply)
this is brilliantly written, thought out, and organized. my sister (sylviasybil) linked me here when a PE assignment made me look up my BMI (body mass index) which told me to rush to a doc cuz i was obese. a, im not obese. over wieght yes, obese no. b, this made me cry =( sissy immedeatly rushed to my side and linked me here. thank you for making me feel better.
ps i also linked my PE teacher and ranted for a little bit… that felt good.
Angel(Quote) (Reply)
Angel, I’m so glad the article helped. I hope your PE teacher gets something helpful from it, too. PE should focus on improving fitness, not decreasing weight. It’s not unusual to gain weight from working out, especially if your body gains muscle way more easily than it burns fat, so concentrating on weight and BMI can be really discouraging. But if PE is making you feel stronger, making your heart rate lower and creating other improvements you can really FEEL GOOD about, then that can encourage you to keep going, and maybe you’ll lose weight, maybe not, but you’ll be healthy. (I OTOH gave up after working out with a personal trainer whose advice put 12 pounds of muscle on me and burnt off no fat at all. That discouraged me so badly that it took years for me to decide, “Screw weight, I’m going to exercise because it makes me feel better.” That, IMO, is the right mindset for exercise.)
Jennifer Kesler(Quote) (Reply)
Sorry for going OT, but what advice was that? I’ve been considering training to build muscle (if I can find a good trainer to help) and it’s my first time ever so anything you can tell me to do or avoid would help.
Cinnabar(Quote) (Reply)
Cinnabar,
She advised the standard sort of workout: 3 times s week, 45 minutes a day of cardio with your heartrate in the “zone”, plus 2-3 sets of 10 reps on each of their 10 (IIRC) weight machines. The problem was, I think, genes – sorry. They have a calculation that tells you what number of bpm your heart should be doing for the optimal cardio workout – it should have you sweating and on the verge of being out of breath. Problem was, I got into the “zone” as calculated by the all-holy numbers, and I was strolling, not sweating, and could’ve sung opera. I kept telling her, “Why don’t we forget the zone, and I’ll just work out until I’m sweating and on the verge of being out of breath?” but she didn’t like that idea. I eventually started doing that behind her back, and I sure felt like I’d had a workout, but no fat came off.
Meanwhile, there are different body types, and mine is definitely the type that builds muscle super easy. I can’t even do strength training on my legs, or they bulk into tree trunks – just my normal walking in a given day keeps plenty of muscle on them. I’m also fairly sure that at times I’ve had a terrific six pack of abs, it’s just they’re buried under some flubber that the “zone” can’t burn off.
It’s all stupid.
Jennifer Kesler(Quote) (Reply)
@Jennifer, I think we’re a lot alike, physiologically. As a thick girl who is muscular but also gains fat like nobody’s business, that “zone” has always been garbage for me.
I mainly want to lose excess fat because it makes me heavy when I try to be active. It feels like I have weighted packs strapped to my body when I try to jog, etc. Not for BS beauty standards (plus, I’ve never been within those standards anyway, and I’ve made peace with that).
JT(Quote) (Reply)
Megan,
Oh, that is totally something I dealt with as well. The weird thing is that I never remember a single person who was actually fat making all the “eat a sandwich” comments; most of the people saying these things were medium-sized people, or those who were thin-but-not-as-thin-as-me. Quite memorably, there was a girl in high school who I thought was a very good friend of mine who one day started making comments about how she was real and she had curves and I didn’t. Anorexia jokes followed me around everywhere. This was a girl who had met my mom on numerous occasions,she could see where my body came from.
That’s why shit like this really bothers me, because a few weeks ago when that was going around my friends’ Facebooks, I felt like it was high school all over again. To me that doesn’t say “fat women are beautiful, too” (which is great), it says “skinny women are crazy people who don’t exist.” It’s not a pro-size acceptance message, it’s just reinforcing the fact that women can never win.
Alyson(Quote) (Reply)
Alyson,
That FB page was making a great point about how fun it is to be a whale… and then came the mermaid hate, like, whoa. (And let’s face it – the image the page has of the beautiful nude fat lady is not without cultural baggage: she’s white with a conventionally lovely face and no visible body hair, and a visible waist line.)
It’s important to remember that absolutely NO WOMAN the media has discovered quite meets their criteria. Even if you’re naturally skinny, conventionally beautiful, naturally lacking visible body hair, etc., they still airbrush the little natural folds of skin every living person has at her armpits so she’ll look unnaturally smoooooth. If you’re an actress and they can’t airbrush you, they’ll pose you in a way that unfolds that skin so you still look unnaturally smooooooth.
And yet, I can attest firsthand that many male actors look exactly or almost exactly the same bumming around in person as they do on screen. That really says a lot right there.
Jennifer Kesler(Quote) (Reply)
Jennifer Kesler,
I personally thing the whole mermaid/whale conundrum is most easily answered with: I’m neither, thanks. I’m an in-the-flesh human woman, whether it’s a one hundred pounds of flesh or two hundred.
In other words: you can be okay with the way you are without being denigrating to those who are not the way you are.
sbg(Quote) (Reply)
You know whats funny? Even my cat gets her weight criticized. I cannot tell you how many times a neighbor or friend has said “wow, shes fat!”. I have to keep explaining that its not fat, its a skin flap that helps her run faster. And she doen’t even look that fat compared to an actual fat cat.
Dina Bow(Quote) (Reply)
Jennifer Kesler,
Thanks!
Cinnabar(Quote) (Reply)
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