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Reader Question - Is Weight-Neutral Health the Same as Size Acceptance
I got a question from reader Sam who asked “I see people talk about Weight Neutral Health, I also see people talk about Size Acceptance, Fat Liberation, Fat Activism and Health at Every Size™. Are these the same thing? If not can you explain the difference?”
Thanks for asking Sam! Before I get started there are a couple of things I want to address. First, while I’m happy to explain how I’ve come to understand these terms and why I use them the way that I do, please understand that I am not in charge of deciding how these terms are used and as our community is not a monolith others will definitely have different ideas. I also want to acknowledge that this is an update of a post I made on my blog, danceswithfat, in 2014.
I think that there are critically important distinctions here. Weight-Neutral Health/Healthcare is a paradigm for approaching health and healthcare including physical and mental healthcare, public and personal health, and social determinants of health. Size Acceptance/Fat Acceptance/Fat Liberation are different names (with many specific definitions) of a civil rights movement. My definition for this civil rights movement the return to fat people of the right to exist in fat bodies without shame, stigma, bullying, or oppression regardless of why we are fat, if there are any “health impacts” of being fat, or if we could become thin. Health at Every Size™ was previously used more or less interchangeably with weight-neutral health and was trademarked by the board of the Association for Size Diversity and Health in 2011 and so has essentially become a brand that is defined and administrated by that organization.
Let’s start with Weight-Neutral Health. First, as always, remember that health is an amorphous, multifactorial concept and is not an obligation, barometer of worthiness, or entirely within our control. Weight-Neutral Health focuses on supporting the health of people of all sizes without utilizing body size manipulation as a healthcare intervention. It includes things like increasing access, removing barriers, and addressing intersectional oppression (racism, ableism, weight stigma, homophobia, transphobia and more.) It should be made clear that when it comes to personal decisions, there is not just one way to practice Weight-Neutral Health. People’s definition and prioritization of health and the path they take to get there are up to them and any health care providers they choose to consult. This is also always couched in the understanding that due to differences in privilege and access, not all people have the same choices (including those who are forced to choose between their weight-neutral health beliefs, and medical procedures that are held hostage through BMI limits.)
I think there is activism to be done around Weight Neutral Health, especially as it relates to information and access (hence this newsletter and a lot of my speaking and other activism.) In terms of information, there is a lot of misinformation out there, even among healthcare practitioners, and so I believe that getting correct information into the hands of practitioners, patients, and advocates is an important harm reduction tool. When it comes to access, again, nobody is required to participate in weight-neutral health or any other health practice, but if someone wants to, then there shouldn’t be barriers to that – they should have access to the foods they choose, movement options they enjoy that are both physically and psychologically safe (so that they can, for example, go swimming at any body of water without any fear of being shamed), and affordable evidence-based healthcare (including practitioners who listen and give weight-neutral interventions.) And remember that food, movement, and healthcare are far from the only aspects of health. They also include things like a thriving wage, plenty of vacation time, enough time to sleep, opportunities to build social connection, not experiencing oppression and more.
On the other hand, Size Acceptance, Fat Acceptance, Fat Activism, and Fat Liberation are terms that are, again, used to describe the various nuances of the civil rights movement that from my perspective asserts that fat people have the right to exist without shame, stigma, bullying or oppression, and it doesn’t matter why people are fat, if there are “health impacts” of being fat, or if people could (or even want to) become thinner.
I believe that Weight Neutral Health and Size Acceptance are two separate things with different, though sometimes overlapping, goals.
That said, I don’t think we should use Weight-Neutral Health as a platform to do Size Acceptance work because I think that we should avoid even the intimation that some level of “health” or “healthy behaviors” (by any definition) is required for access to basic human respect and a life without shame, stigma, bullying or oppression. There is absolutely NO health requirement to demand our civil rights. Nobody owes anybody else “health” or “healthy habits” by any definition. The rights to life, liberty, and the pursuit of happiness should never be size (or health or healthy habit) dependent.
As someone who engages in work around both Weight-Neutral Health and Size Acceptance, I always try to be clear that they are not the same thing and that there are no health requirements to be part of the Size Acceptance movement.
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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 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Note I don’t link to everything I discuss in this post because I don’t want to give traffic and clicks to dangerous media.