On size acceptance

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.

Comments

  1. sbg says

    +1

    You know this has been a recently pushed hot button for me. I wish I was more assertive with doctors, but I go in kind of on the defensive already because I know what’s coming. Then it comes, and I get so flustered and frustrated I totally lose it. So, some of the onus is on me. But at the same time, if I say, “Hey, I’ve noticed some discoloration on my skin, I’d like to see a dermatologist.” I rather expect that’ll be taken more seriously than me pointing to weight on a checklist of issues the doctor wants to know I’m concerned about (a list which included nothing else troublesome to me) and the visit becoming all about that, and not the potential skin cancer.

    ETA: Mind you, I would love to lose 20 lbs, but my health has nothing to do with it. It’s my own personal preference and a closet full of clothes that could look and fit much better if I did.

  2. says

    sbg,

    Ugh, yes. I went to a women’s health clinic to get my birth control script renewed. The conversation I had with the nurse-practitioner went along the lines of:

    NP: You understand, your obesity means the pills won’t be as effective for you.
    Me: Okay.
    NP: This dosage was calibrated for someone half your weight, so it will be spread twice as thin throughout your body.
    Me: *thinking simultaneously “someone half my weight would be well below the average American woman” and “if calibration is that important, why don’t you have higher dosages?” * Okay.
    NP: And really obesity is unhealthy in all aspects.
    Me: Okay.
    NP: Here’s a pamphlet on how to eat healthily.
    Me: Do you need anything else before you can give me my pills?

    On my way out the door, she reminded me that my pills would have reduced effectiveness due to my weight. Somehow I doubt that’s true, given that no other health professional who has prescribed me BC has said that to me. And since it was a charity clinic, I didn’t feel I could say anything about her behavior.

  3. Maria says

    Sylvia Sybil,

    http://www.sciencedaily.com/releases/2010/08/100816155006.htm

    ScienceDaily (Aug. 16, 2010) — The first study to compare the effectiveness of the birth control pill in women with marked weight differences has found that the pill works equally well in women with obesity and thinner women. This new finding by physician-scientists at NewYork-Presbyterian Hospital/Columbia University Medical Center refutes a long-held conviction among many doctors that the pill may not reliably prevent pregnancy in women who are overweight or obese.

  4. Maartje says

    Oh how I have been there. I have a 5k range where I like to stay in, because I feel good within that range. And I have kept within that range for the last 5 years (I’m 25). However, that range comes with a BMI of (on average) 27. Never mind that I feel good, that I’m athletic, strong and have had professionals measure where the fat’s at (hint: it is nowhere near the danger zones) because it’s an INDICATOR, I should get my BMI down to 25 according the good doc. Heeeelll NO.
    Of course, I do get into angry lecture mode when I am discussing this, so I guess that might not be helping things along.

  5. says

    [I've allowed this comment through to demonstrate what we're dealing with AND refute her plausible-sounding claims. Mods, please do not trash. - Jennifer Kesler]

    ” As long as your other numbers are good, your weight does not impact your health.”

    This is just so wrong-headed and dangerous.

    Weight affects your joints making it more likely you will be younger when you need a knee replacement. Obesity even with “good numbers” increases the morbidity of all surgical procedures, and increases the risks associated with anesthesia.

    Fat impacts healing, blood supply to adipose tissue is not that good, so healing adipose tissue is more difficult and it takes longer, complications( infection, dehiscence of the surgical wound), are more likely.

    Obesity causes the heart to work harder, aging it faster than the heart of those who are of normal weight . Obese people are often less active this causes venous statis which increases the risk for pulmonary emboli.

    Bringing people to a more normal weight often solves a very big medical problem, High Blood Pressure. HBP is often the cause of Kidney failure, Heart Failure, and contributes to Liver Failure.

    That is just to start, and does not even go to some credible studies regarding adiposity and colon cancer.

    So, to think that only the numbers matter is frankly ridiculous.

  6. says

    sbg,

    How is that NOT just malpractice? Melanoma is one of the most lethal cancers around, and fortunately can often be prevented by catching and removing in pre-cancerous stages, but let’s worry about twenty pounds instead!

    Maria, Sylvia Sybil,

    Thanks for the link, Maria, because what Sylvia Sybil relayed from her doc sounded like complete bullshit to me. Once again, doctors have just made up something that sounds logical, hurled it like a bludgeon at lots of women, and THEN someone has actually bothered to do a study and OOPS.

    Maartje,

    I probably should have mentioned BMI. It’s really NOT an indicator of anything, not even how much fat you have: http://www.npr.org/templates/story/story.php?storyId=106268439. It certainly doesn’t indicate anything about health, but does that stop insurance companies from using it to screw people out of services? Oh, no, not in the US at least.

  7. Maria says

    Maria,

    Jennifer Kesler,

    I had the link to the actual study for a while, because I’ve brought it up to gynos before. My present gyno (who’s amazing) explained that you might get break through bleeding if you’re overweight, but that’s not indicative of effectiveness.

  8. says

    giilian: This is just so wrong-headed and dangerous.

    *scans gillian’s post, sees no links to back up her claims* It’s so nice when a direct messenger from God Almighty pops ’round to tell us clowns how it really works! /sarcasm.

    And this person’s email address suggests she is a doctor. What a surprise.

    Weight affects your joints making it more likely you will be younger when you need a knee replacement.

    “When” you need a knee replacement? Are you for real? Did you somehow miss the part about my family tree is overflowing with obese people who live consistently into their 90s without ANY of the health problems correlated with obesity? Well, in case it wasn’t clear, none of them ever needed knee replacements, either. How credibility-bombing to suggest fat people always need knee surgeries.

    But maybe you just chose a word wrongly. Let’s continue and not harp on that one so much.

    Obesity even with “good numbers” increases the morbidity of all surgical procedures, and increases the risks associated with anesthesia.

    Bullshit. It’s so helpful when people actually study something enough to get the truth of it.

    Fat impacts healing, blood supply to adipose tissue is not that good, so healing adipose tissue is more difficult and it takes longer, complications( infection, dehiscence of the surgical wound), are more likely.

    But can be rendered a non-problem by, like, skilled surgery instead of the usual butchery. (Sorry, a Jehovah’s Witness friend whose religious precludes blood transfusions has been educating me about get-‘em-in-get-‘em-out surgical techniques that result in unnecessary tissue trauma and blood loss.)

    Obesity causes the heart to work harder, aging it faster than the heart of those who are of normal weight . Obese people are often less active this causes venous statis which increases the risk for pulmonary emboli.

    And which part of this doesn’t show up in the same blood panels alongside “the numbers that matter”? If your doctor feels your heart rate is too high at rest, then – as with cholesterol and others I named – that could be a reason for her to advise a diet and exercise strategy that will get it under control. Duh?

    Bringing people to a more normal weight often solves a very big medical problem, High Blood Pressure. HBP is often the cause of Kidney failure, Heart Failure, and contributes to Liver Failure.

    And again, bp is one of the numbers that matter, and while losing weight can help with it, it’s typically more important to reduce salt intake, at least in the typical American diet. Remember all the healthy fatties in my family tree? Most of us have LOW blood pressure until we get into our 70s, at which point it becomes normal or high.

    That is just to start, and does not even go to some credible studies regarding adiposity and colon cancer.

    Once again, bullshit. Consuming animal fats or a high fat diet – something that some skinny people do a lot of and some fat people do none of – is what the study suggests may cause colon cancer. How is it I can find this out and you can’t?

    So, to think that only the numbers matter is frankly ridiculous.

    Frankly, your entitled ignorance is appalling.

  9. Korva says

    Interesting, thank you. The obsession with a woman’s weight is really sickening. Hell, I’m slim and I not only don’t give a whit about sex appeal and “femininity” and never did, I actively try to avoid these things … yet the nagging inner voice is still there sometimes. It’s nasty to imagine how much worse it must be for women who are chubbier — not to mention the very real health risks you outline here. Health risks that do not result from one’s weight but from others’ perception of one’s weight and overlooking the real issues. How utterly messed up is that, especially when it comes from professionals who should know better?

    And I’m sure that in many cases it’s deliberate. For example, selling the diet fad of the week is a lot easier if the target audience is already insecure and full of misinformation and self-hate … Maybe the awareness that fat-shaming is, among other things, yet another aspect of the omnipresent message that women are wrong, ugly and disgusting the way we naturally are and must undergo all sorts of expensive, questionable contortions to even come close to the point where we would be “allowed” to feel like a worthy human being can also be a part of size acceptance?

  10. says

    Maria,

    Linkie says:

    did not rely, as previous studies had, on women’s recollections of how much they may have weighed at a time when the pill had failed and they became pregnant.

    WHAAAT. Sciencey people – medical sciencey people, who study how to keep people alive – were relying on self-reporting of memories surrounding a body status many people have skewed perceptions of (size), dependent on a variable associated with weight (pregnancy)? I count at least four flaws here.

    And thank you for the link. :D

  11. says

    giilian,

    Okay, let’s start with some basics here. Of my four grandparents, three of them lived past ninety. My paternal grandfather dropped dead of a heart attack one morning in his late seventies or early eighties (I think – I was about 10 at the time). My maternal grandfather (who was on oxygen for the last year or so of his life) died at the age of 93; my paternal grandmother died of a stroke about a month before her 93rd birthday (she was the only one who’d been “normal” or low weight all her life); and my plump, cuddly maternal grandmother finally died off about four years ago, at the age of about 95, from complications stemming from insufficient pain management from a broken bone in her hip caused by a fall.

    Weight affects your joints making it more likely you will be younger when you need a knee replacement. Obesity even with “good numbers” increases the morbidity of all surgical procedures, and increases the risks associated with anesthesia.

    Fat impacts healing, blood supply to adipose tissue is not that good, so healing adipose tissue is more difficult and it takes longer, complications( infection, dehiscence of the surgical wound), are more likely.

    None of my relatives ever needed a knee replacement. My maternal grandmother had a hip replacement in her late 80s. The only relative I know of who’s needed abdominal surgery was my maternal aunt (Mum’s sister), who needed it to deal with ovarian cancer. That was about 20 years ago, she’s still going strong. I strongly suspect the surgery itself was done via laparoscopy, so minimal incisions, minimal damage, and thus minimal healing time required.

    Bringing people to a more normal weight often solves a very big medical problem, High Blood Pressure. HBP is often the cause of Kidney failure, Heart Failure, and contributes to Liver Failure.

    My maternal grandfather had chronic low blood pressure throughout his life (I think his wife’s blood pressure was a little on the high side, but that was correctable with medication). I’ve inherited that through my mother (who also has low blood pressure – she can feel faint hanging out laundry), so it seems my liver, kidneys and heart will all be safe for a while longer.

    As for colon cancer – I also appear to have inherited the family tendency (maternal side) toward irritable bowel syndrome, which I understand is something of a contra-indicant for a tendency toward colon cancer.

    One other little inherited tendency I picked up from both sides of the family: I have chronic depression (which I strongly suspect is actually bipolar II). Which means when I have well-meaning, charming people like you telling me how I’m going to drop dead Any Fucking Day Now, all I can think is “well, that’ll be a nice change.” I’ve no real wish to die, and no active plans for suicide, but I’ll tell you what, there are a lot of mornings where waking up feels like a huge betrayal. Because one of the wonderful things about the fat-shaming which has spread through Western culture like a cancer from the lovely US of A since the 1960s is it means I really can’t think of any particular reason why I’d actually want to live.

    As someone at Shapely Prose put it once: if shame worked as a way of keeping people thin, there would be no fat people.

    Do me a fucking favour, gillian (if you’re still reading, if you didn’t just drive by to drop off your load of shame and humiliation and nastiness). Have a look at the morbidity rates from depression, and tell me – of the spare 50kg or so I’m carrying on my hips, and the salesdemon for suicide I’m carrying in my head, which one is more likely to actually kill me in the next forty years?

    PS: I’m 40 now, and from family averages, it looks like I’ve at least another what, 50 years to look forward to…

  12. sbg says

    Jennifer Kesler,

    Sometimes I wonder if people read posts about acceptance as some sort of battle cry for all people to go out and get fat. I think they don’t even know why they feel that way, but I’m sure it’s a lot to do with why the lingering skinny = healthy/fat = unhealthy unequivocally is such a hard mentality to break. Neither are 100% true, yet everyone believes the epitome of health is being as thin as possible and being fat will kill you and cost the nation billions of dollars.

  13. depizan says

    The book The Obesity Myth is a good one as far as the whole weight/health, well, myth goes. More people should read it.

    Starting with my workplace’s wellness committee and our insurance company. My workplace has a wellness initiative, you know, to get everyone to eat better, exercise more, and lose weight. Because everyone needs to lose weight, amiright. I’ve tried to explain what’s so horribly wrong with this, but no one seems to be listening. I couldn’t even finish the health assessment that kicked the whole thing off because it required me to agree to manage my weight. The thing isn’t mandatory, but it is really disgusting.

  14. says

    Megpie71,

    Wow. If you weren’t a year older than me, I’d think we were separated at birth. I just… 99% of your post, I could say “ditto.”

    sbg:
    Jennifer Kesler,

    Sometimes I wonder if people read posts about acceptance as some sort of battle cry for all people to go out and get fat. I think they don’t even know why they feel that way, but I’m sure it’s a lot to do with why the lingering skinny = healthy/fat = unhealthy unequivocally is such a hard mentality to break. Neither are 100% true, yet everyone believes the epitome of health is being as thin as possible and being fat will kill you and cost the nation billions of dollars.

    This is a great point! People tend to infer extremes into any statement you make against the status quo, i.e., “women’s rights are not quite what they should be” becomes “we hate and wish to crush men under our heels.” I see that bizarre way of thinking so often that it makes total sense that just stating that “fat is not evil” could be reinterpreted as “we should all get fat, it’s awesome!”

  15. says

    Another small thought: my background, class wise, is largely working class. I’m in the first generation in my extended family where all the kids were able to go to university. Of my parent’s generation, my mother and her sister were nurses (taught by the old “apprenticeship” system), my father did the equivalent of a technical college diploma to become a minister of religion (and a brief apprenticeship to become a mine assayer’s assistant), my father’s brother did the equivalent of an apprenticeship to become a radiographer (he used to operate x-ray machines), and my mother’s brother had the option to go to university, but instead got a number of untrained semi-professional jobs here and there around the country town he lived in (doing things which ranged from providing advice to farmers in the region to office work through to computer programming – self-taught – and finally to providing handyman services for one of the local motels).

    We’re all descendants of people who survived on low or very low income levels (one of my great-grandfathers was a miner, another was, I think, a tenant farmer in Yorkshire) through adverse times and disease. I’m a descendant of people who didn’t get days off for being sick, who couldn’t recline on the sofa after childbirth and hand the children over to the nurse (my female ancestors were more likely at best to have been the nursemaids or housemaids, and might possibly have got the actual day of physical labour off, but they would have been expected back to work as soon as possible shortly afterwards) and who didn’t get weeks or months of convalescent time to recover from illnesses. So yeah, it’s possible my genes might have been shaped by a different set of social and cultural selectors to those of some upper-middle class executive with at least three generations of inherited wealth before him to cushion the impact of reality.

    All of which points to the very real truth that people are individuals, and that no general rule is true in all cases. There are always exceptions. This includes those rules about the risks of being fat. I come from a social and cultural background which most likely selected for being able to put on weight in good years, hold onto it tooth and nail through the bad years, and survive through the worst years without actually falling ill. It shaped the way my body looks (I’ve been told I “don’t look that fat” when I tell people what my clothing size is) and the way my body handles the way it looks. I have solid bones, a great deal of physical strength for my size, and a tendency to put on flesh. I’m a peasant, and I fucking well look like one.

    And you know what? I’m damn proud of it. My ancestors did the same as everyone else’s. They fucking well survived. That’s the prize, after all.

  16. says

    sbg,

    EXACTLY. But anything more would be COMPLICATED, and we don’t want to think! Hell, just today, we’ve decided how many creamers to put in our coffee, which route to take to work, and whether to respond to emails now, or after coffee. Life is HARD. /sarcasm

    Megpie71,

    That sounds very much like my background. It’s also interesting to note that many of my ancestors (and it sounds like yours, too) did a lot of physical labor most days of their lives, walked more places than they drove to, and had access to good, locally farmed foods… and yet they still weren’t slim. So the old “Oh we’re all fat because we eat processed foods and drive everywhere and aren’t active” it another bit of bullshit that sounds logical until you, like, compare it with reality.

  17. Gabriella says

    sbg,

    As to skinny=healthy, my sis is 165cm/50kg and would live off KFC if there was no-one to cook for her. Never seen her excercise, either. It wouldn’t surprise me if those numbers of hers are terrible. But she’s super-skinny so apparantly, she must be super-healthy, too :8

  18. says

    Jennifer Kesler,

    I tend to find myself wondering about these people who are all terrified about TEH DEATHFATZ – what on earth do they think is going to happen should they live a long and healthy life, exercising religiously, avoiding saturated fats, avoiding all the red meat, keeping healthy all the way… do they think their $DEITY_OF_CHOICE or the universe at large is going to look down at them and say something along the lines of “Oh, you’ve been such a Good Boy/Good Girl, you shall Live Forever as a reward”? I suspect they’re going to be deeply disappointed when they wind up dying just like the rest of us sinners.

    A few of the things which get me about the whole business of the DEATHFATZ health kick thing are as follows:

    * Nobody yet has been able to give me a solid figure as to how many years I’d gain through following their particular little religion.
    * None of them seem to have realised that the extra years I’d purportedly gain will be added to the far end of my life, when I won’t want them anyway (being more than likely as senile as all get-out… both of my grandmothers were senile when they died, and let me tell you, that is the one thing I fear about ageing.)

    There seems to be a few underlying assumptions to the whole business that nobody really stops and examines – such as the underlying assumption that if one Does Everything Right, one should be able to avoid dying indefinitely; and that Everyone is equally terrified of the prospect of physical death; and that not being terrified of the prospect of physical death is somehow abnormal. Well, maybe I am abnormal – but I’ve embraced the notion that one day I will die, and that one day my physical presence on this world will end, and one day my consciousness will stop. So I’d rather live the life I have now, rather than continually putting off living until I’ve lost five kilos. Because that One Day might be tomorrow, my physical death might come as a result of a piece of falling space junk, and I’d hate to die with regrets.

  19. Dom Camus says

    Leaving aside that whole debate about the difference between statistical correlation and causal relations, there is a point I think is important to make about size acceptance here:

    Size acceptance is not fundamentally about arguing that all sizes are equally healthy. It is about treating people with equal respect regardless of their size. And yes, that would still apply to the case of a person whose size was a medical problem for them.

  20. KLee says

    This is so true. In particular, the point about ignorant doctors. Now I freely admit that I am severely overweight, that for my long-term health I need to/must lose some more weight. And I know I feel better when I lose some pounds, as I have had reinforced over the last 6mos as i slowly worked my way down 20 lbs. I am happy to talk to my favorite clinic doctor about this, and I have because it is a life-long battle that impacts me psychologically, as well as the impact on important numbers as I discovered last time I had my cholesterol checked. However, when I visit a doctor I do not want the entire focus to be on that to the exclusion of my other health concerns that may be more immediate.

    For example, there is one particular doctor at the clinic I use that I refuse to see anymore unless there is absolutely no other choice, the receptionist knows this. I’m sure he is a fine doctor & he is actually quite nice; however, on several occasions where I was there for a random ailment and he turned the discussion to my weight for no reason other than I’m overweight I guess. I could tell he was sincere in his concern, but I decided I didn’t need to put up with the aggravation nor the (perceived?) criticism that was playing into the bad aspects of the major depressive episode I was battling at the time. I don’t need him, or anyone else to point out the obvious, I can see it in the mirror every day.

    Tangentially related, I get really annoyed by the blanket statement of ‘you need to exercise more & eat less.’ So not helpful. I know I need to exercise more. But eat less? No, IMO its about knowing what you are eating, paying attention to portion sizes, eating regularly, and knowing how what you eat impacts your cholesteral, or blood pressure or blood sugar etc.

  21. depizan says

    sbg,

    Exactly. If they’d stuck with the goals of eat better and get more exercise, I’d be all for it. But no, they just had to tack on “lose weight.” It’s a classic case of one of these things is not like the other. The science isn’t there for weight loss and there’s a huge difference in the emotional loading of the goals. For everyone. It’s different to, say, be a marathoner faced with a workplace goal of “get more exercise” than it is to be a thin person faced with a workplace goal of “lose weight.” One is just silly and the other might well be the beginning of an eating disorder. Likewise, it’s very different to be a couch potato faced with a workplace goal of “get more exercise” than an “overweight” person faced with the goal of “lose weight.” The couch potato might feel shame, but the overweight person almost certainly will.

    I’d love to see a wellness program, workplace or otherwise, that was centered around making people feel good.

  22. says

    I just had a thought…how come tobacco smokers don’t get this kind of treatment, since tobacco has a proven, direct connection to cancer? Tobacco is romanticized as a symptom of a bad-boy, devil-may-care attitude; struggling to quit tobacco is romanticized as a family-friendly inspirational about overcoming drug addiction.

    Other than paying more for health insurance and a few isolated anecdotes (half of which are “jerk didn’t want me polluting the air she was breathing, can you believe the nerve?”), I can’t think of any discrimination tobacco smokers face. I can’t think of any place where they’re demonized for their “choices” or made to look subhuman. I can’t imagine a show like Mike & Molly with a hook of “two tobacco smokers meet at Nicotine Anonymous and begin a relationship”; nor can I imagine Marie Claire running a blog post talking about how much the sight of smokers grosses the writer out and how they shouldn’t even be allowed on the air.

    So it’s really not about health. Could it be because tobacco use doesn’t greatly affect one’s adherence to social standards of beauty (at least not for years), while obesity does? Hmm.

    Dom Camus,

    Very good point. Even in those cases where obesity is the result of a vice, that doesn’t justify treating them as less than human.

  23. sbg says

    Sylvia Sybil,

    Well, there’s an awful lot of public policy and law about where smokers can and cannot smoke, which – I’ve heard – is apparently in some smoker’s corners seen as an infringement on their rights. I’m pretty sure there’s an employer in my city that will not hire a smoker (!). Plus, many wellness programs do include smoking cessation, and I think it’s because most really agree that smoking is not good for you.

    But you’re right, it’s not nearly as hyped. Every time I think about the “obesity epidemic”, I get that awful Lipozene commercial in my head, and how the “fat model” is always a woman.

  24. Casey says

    sbg,

    They just said, It’s not your fault, and then they said its caused by poor diet and lack of exercise… how is that not you fault!?!?!?! They’re stupid!

    Grrr, Youtube comments…somebody doesn’t seem to understand the extenuating circumstances that can lead to a lack of exercise and poor diet.

  25. Korva says

    In parts of Europe, at least, smoking has been losing some of its romanticized air. About time, too (says someone whose body reacts very strongly to nicotine fumes). I can mainly speak for Germany, where the “you’re infringing on my freedom to damage others’ health wherever I wish” crowd has been losing quite a bit of ground. Most smokers appear to accept it gracefully, too.

    Here’s another issue that’s actually known to seriously damage the health of and kill people, yet sees much less of a public outcry or awareness than the oh-so-terrible “fat”: the other end of the weight scale. Anorexia. Bulemia. The works. Yes, there are small, slow steps being taken against it too — but not nearly enough, and our society still for the most part collectively wets itself in glee at the sight of women who are literally starving themselves. THAT is where the endless unquestioned “You must lose weight!” mantra leads in its final consequence. How can that still be considered admirable and desirable, while a strong, solidly built, healthy-as-a-horse person (Megpie7, your self-description is great) is vilified? It’s one of those things that make my brain want to to check out with a “divide by zero” error.

  26. Goldenblack says

    Thing I am currently wondering:

    Why is my BMI being measured at the moment by one of the doctors I see? I am 32 weeks pregnant.

    At least my trainer (I was a gym bunny prior to pregnancy) loathes BMI utterly. He was more worried about appropriate heart rates, etc. Admittedly, his own doctor told him he was obese. He had a tiny percentage of bodyfat, but was very, very muscled and weighed quite a bit.

  27. says

    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?

  28. Alara Rogers says

    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.

  29. Alara Rogers says

    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*.

  30. Megan says

    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

  31. Casey says

    Megan: (as he’s not particularly attracted to twelve-year-old boys)

    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.

  32. says

    Alara Rogers: 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*.

    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.

  33. Megan says

    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.

  34. Casey says

    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.

  35. Megan says

    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.

  36. Patrick McGraw says

    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?

  37. Casey says

    Megan: I think in this context I was using it in a self-deprecating manner in some twisted attempt to apologize for having been skinny?

    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*

  38. Maria says

    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.

  39. Casey says

    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.

  40. says

    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.

  41. says

    Jennifer Kesler,

    “When” you need a knee replacement? Are you for real? Did you somehow miss the part about my family tree is overflowing with obese people who live consistently into their 90s without ANY of the health problems correlated with obesity? Well, in case it wasn’t clear, none of them ever needed knee replacements, either. How credibility-bombing to suggest fat people always need knee surgeries.

    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.

  42. Angel says

    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.

  43. says

    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.)

  44. Cinnabar says

    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.

    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. :)

  45. says

    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.

  46. says

    @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).

  47. says

    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.

  48. says

    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.

  49. sbg says

    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.

  50. Dina Bow says

    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.

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