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.
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.
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.