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I got this question recently:
“I’ve been seeing articles that say that being fat* is considered a “chronic lifelong condition.” Can you explain what’s going on to me?”
I’m happy to try! First, some background.
In 2012 the American Medical Association charged its Council on Science and Public Health with studying whether or not ob*sity* should be considered a disease. One year later it ignored that council’s recommendation to declare that it is.
To be very clear, there is absolutely no shame in having a health issue of any kind, but I think that there is shame in the actions of the AMA.
Does that mean that Tom Cruise needs to start diet pills? Does Dwayne Johnson have to sign up for Weight Loss surgery? After all, they are ob*se by the clinical definition, and ob*sity is a disease per the AMA. So you can start to see why the Council on Science and Public Health thought this was a bad idea. It makes body size the “disease,” it makes changing body size the “cure,” and nobody has to take any health measurements at all. This does not have the feel of sound science. (There is also a racist basis and history here, please read Sabrina Strings’ Fearing the Black Body: The Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to learn more about this.)
But really, it’s just the Council on Science and Public Health and what do they know about science and public health er, I mean making a profit for pharmaceutical companies?
“Companies marketing the products will be able to take this to physicians and point to it and say, ‘Look, the mother ship has now recognized ob*sity as a disease’” said Morgan Downey at the time of the decision. Downy is a a self-identified “advocate” for ob*se people, and publisher of the online Downey Ob*sity Report.
I’ve got to ask, with “advocates” like this, who needs detractors? Dig a little, and you learn that Morgan gets paid to consult for organizations that represent companies that market these products, so it was a good day for him.
In a blatant attempt at “if wishing made it so” the AMA resolution just simply stated hypotheses as if they were facts:
Whereas, Weight loss from lifestyle, medical therapies, and bariatric surgery can dramatically reduce early mortality, progression of type 2 diabetes, cardiovascular disease risk, stroke risk, incidence of cancer in women, and constitute effective treatment options for type 2 diabetes and hypertension…
It’s important to note that there is not a single study that proves this (and, in fact, the research shows the opposite.) The AMA apparently forgot the last sentence which is “We guess?” They also ignore the fact that many fat people never develop these issues and plenty of thin people have them. Not to mention that one reason good research doesn’t exist is that so few people have lost weight long term that there aren’t even enough to study. That’s because there aren’t any weight loss methods that are shown to work long term for more than a tiny fraction of participants, and often the “successful” weight loss amounts to 2-5 pounds. There’s weight loss surgery and diet drugs, but those risk patients lives and quality of life with almost no long-term data.
So against their own learned committee’s recommendations the AMA declared existing in a fat body to be a disease. No actual health measurements are necessary in their estimation, just a quick ratio of your weight and height and they pathologize your existence accordingly. They aren’t the first health organization to do this, but no matter how many organizations say it, it’s not actually medically or scientifically sound (but don’t just take my word for it, ask the AMA’s Council on Science and Public Health!)
Fast forward to now. The word is getting out that intentional weight loss interventions don’t work to make fat people thinner or healthier, and that almost everyone gains their weight back long-term. That’s not great news for the diet industry, including companies who sell “treatments” that are extra dangerous and extra expensive, like drugs and surgery.
So these companies have been pushing a narrative wherein being fat is not just a “disease” but is, in and of itself, a “chronic and lifelong health condition.” They’ve pushed this narrative though many channels, perhaps the most insidious is through organizations that claim to be “advocacy groups” for higher-weight people but are, in fact, fully funded by (and function as lobbying arms of) the drug and surgery companies (looking at you, “Ob*sity Action Coalition.”)
This narrative provides a lot of benefits to these weight loss peddlers, including:
1. Expanding their market (to literally anyone who is fat)
2. Helping them make a case that health insurance should cover their dangerous and expensive “treatments”
3. Helping the drug companies work around the fact that as soon as people go off the drugs they gain their weight back
4. Allowing drug companies to sell drugs to people for their entire lives
There’s just one itty bitty problem…it doesn’t make any sense. There are people of the same weight who have vastly different health statuses, and there are people of vastly different weights who have the same health statuses. And blaming health conditions on fat bodies rather than on the weight stigma, weight cycling, and healthcare inequalities fat people experience is beyond dubious.
While this concept drives a ton of profit to the weight loss industry, it also drives a ton of harm to fat people. There is absolutely no shame in having a chronic lifelong health condition – or health conditions of any kind. There is no shame in getting treatment. This is isn’t that. Pathologizing a body size subjects fat people to “interventions” that drive profit to the weight loss industry while risking our lives and quality of life, all under the guise of “healthcare.”
So if someone tries to tell you that simply existing in a fat body is a “chronic, lifelong health condition,” you might tell them that whatever they’re selling, you’re not buying it.
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Hi Ragen. I love this Substack, so much great info. As mentioned before, I'm getting ready for a visit to my HCP after a fairly big weight gain. I want to be prepared for whatever she throws at me about T2 diabetes. I looked at the HAES resource sheet for T2D and it states quite specifically that T2 is genetic and not a result of eating choices. I really wish there was a citation for that considering it flies in the face of conventional wisdom. Do you have any citations? I'm going to do some googling but am fully expecting to have to slog through a bunch of BS before I find anything.