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I received this question from reader J’Alice:
I recently heard somebody say that ob*sity* is an addiction just like alcohol or gambling, but that sounds wrong to me. Can you explain?
Thanks for the question J’Alice! You’re right, it’s wrong. Let’s dig into this a bit:
I want to start by being perfectly clear that there is absolutely no shame in having an alcohol use or gambling disorder, however they aren’t the same thing as “ob*sity.” While fully recognizing that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is problematic in many ways and certainly not the end-all-be-all, the diagnostic criteria that it provides for each of these conditions can provide some clarity.
The DSM-5 defines alcohol use disorder as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of the following 11 symptoms occurring within a 12-month period. The number of symptoms determines the severity: 2 to 3 symptoms for mild AUD, 4 to 5 for moderate, and 6 or more for severe.
The DSM-5 defines gambling disorders as a persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period and the gambling behavior is not better explained by a manic episode.
Now “ob*sity” is not in the DSM 5. That’s because the “diagnosis” of “ob*sity” is simply a BMI or Body Mass Index (weight in pounds times 703 divided by height in inches squared) that is greater than or equal to 30. People who meet this criteria do not have shared behaviors that are different than those of people who are not “ob*se” nor do they have shared symptomology that is different than those who are not “ob*se".”
Drawing this into sharper relief, those with alcohol use and gambling disorders share behaviors, those with “ob*sity” share a height/weight ratio. These are not the same.
The assertion that “ob*sity” is the same as substance use or gambling disorders is based on stereotypes of fat people and food - what and how much they eat, what their relationship to food is, and the continued perpetuation of the myth that body size is a simple matter of calories in calories out. Even the weight loss industry is starting to admit that this isn’t true (albeit only in an effort to co-opt decades of work done by fat activists and weight-neutral health advocates so that they can sell more dangerous and expensive diet interventions, but nevertheless they admit it.)
In truth, fat people are not a monolith and they have all the same eating habits and relationships with food as thin people do. Whatever eating behaviors a fat person has, there are thin people with those exact same behaviors. There are also fat people with all types of eating disorders but, again, stereotypes and weight stigma often lead to eating disorders being undiagnosed in fat people, or to healthcare providers (including those who are considered eating disorders “experts”) who believe that the only eating disorder that fat people can have is Binge Eating Disorder, and/or that all fat people have Binge Eating Disorder.
Another issue here is the concept of food addiction. While I do not wish to minimize the experience of those who identify as having, or having had, food addiction I do want to point out that it’s a controversial concept. Without doing a deep dive into this (at least not today) I’ll also point out that the feelings associated with the idea of food addiction may be a direct response to the food restriction that typically accompanies intentional weight loss attempts, since our bodies respond to this in a number of physiological ways, including by increasing the hormone that causes hunger and decreasing the hormone that signals satiety. For example, in studies of rodents and sugar, the rodents who display “addiction” behaviors are typically the rodents for whom access to sugar has been restricted. Also, the idea of being “addicted” to something that you require to live is problematic. That said, even if food addiction were a substance use disorder, it is still not the same thing as “ob*sity” since, again, ob*sity is just a height/weight ratio - there are thin people who identify as experiencing food addiction and fat people who do not.
The idea of pathologizing higher weight bodies is rooted in racism and anti-Blackness and and continues to disproportionately impact those communities today (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 a deeper understanding of this.) It is also pushed by the weight loss industry for profit. When someone (including, unfortunately, healthcare professionals) mixes that pathologization with weight-stigma driven stereotyping, you get the absolutely false idea that you can diagnose behaviors based on body size. This leads to plenty of harm including healthcare practitioners who not only give doomed-to-fail weight loss advice, but in doing so often tell fat people to eat less and exercise more without even bothering to ask how much their patients eat or exercise (or choosing to believe their stereotypes over what their patients tell them.)
Body size is not behavior and anyone who claims that it is is operating out of ignorance, weight stigma, or both.
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More research and resources:
https://haeshealthsheets.com/resources/
*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.
Ah, yes, the old "Since overeating is the 'only way' to become fat, all fat people must have a food addiction and overeat."
I once again wonder why basic logic isn't taught to school kids. Starting with "If your original statement is garbage, what does that make your conclusion?"
Perhaps off-topic, but I wanted you to see this -- an article in today's GUARDIAN.
https://www.theguardian.com/lifeandstyle/2023/oct/12/dont-cheer-the-scale-doctors-and-dieticians-untangling-body-size-from-health