The Difference Between Size Acceptance and The Weight-Neutral Health Paradigm

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While they are often erroneously conflated, size acceptance and weight-neutral healthcare are two separate things with separate, though sometimes overlapping, goals.

Size acceptance is about the fact that fat* people have the right to live without shame, stigma, bullying, or oppression regardless of why they might be fat, what any “health impacts” of being fat might be, and if they could/want to become thin. The rights to life, liberty, and the pursuit of happiness are not, and should not be, size (or health) dependent.

This is a civil rights movement and so, like all civil rights movements, the rights should not be up for debate. Fat people aren’t asking to be given these rights, they are asking that people stop taking them away through an inappropriate use of power and privilege. “Health” or “healthy habits” (by any definition) are not required to be covered by size acceptance.

Now let’s talk about weight-neutral healthcare. This is an evidence-based health paradigm – including mental and physical healthcare, public health and personal health – where the focus is on supporting health directly, rather than focusing on body size and body size manipulation. It acknowledges that health is a multi-factorial amorphous concept and is not an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstances.

The focus of weight-neutral healthcare is to bring down barriers, create access, and improve social determinants of health while respecting people’s prioritization of their health and the path and support they want.

There is certainly plenty of activism to do around weight-neutral healthcare. Nobody is required to practice this or any other health practice, but if someone wants to practice health supporting habits, there shouldn’t be barriers to access. People should have access to the foods they want to eat. They should have access to movement they want to engage in, and that movement should be both physically and psychologically safe (so that everyone can, for example, go swimming anywhere without any fear of being body-shamed.) They should have access to affordable, ethical, evidence-based, weight-neutral healthcare. And they should be born and age in an environment free from oppression where they are affirmed and supported. There is tons of work and activism to be done around removing barriers and increasing access and it’s really important work to do.

That said, it is not the same thing as activism around Size Acceptance. It is important to make a clear separation between the two, lest people get confused and think that some level or commitment to “health” or “healthy habits” is required for access to basic human respect and the rights to life, liberty and the pursuit of happiness, and ethical, evidence-based healthcare There is absolutely NO health requirement to demand civil rights and equal treatment. Everybody deserves basic human respect and civil rights and that should never be up to a debate, show of hands, or vote of any kind.

Fat people have a right to exist, there are no other valid opinions about that. Our rights to respectful, equal treatment – including in healthcare - should never be someone else’s to give or take, they are inalienable.

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More research:

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.