Truths About Health and Fat People

What I Wish I Said On The Doctors

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During my appearance on the show The Doctors, some of what I said was edited out and some things went unsaid. Whenever I do an appearance like this, or a talk of any kind, I lose sleep thinking about the things I could have said differently or better, and this was no exception. But as I watched the episode, there was a glaring omission that I wish had made it on the air. Whenever I talk about health, I try to say:

Health is an amorphous, multi-factorial concept and is not an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstance.

Today I want to do a deep dive into this because these concepts lie at the intersections of weight science, weight stigma, and healthcare.

Health is an amorphous, multi-factorial concept

In our culture we tend to act as if “health” is a clear, simple concept – something you could throw a dart and hit. In fact, health is an amorphous concept that includes a number of factors, many outside of our control. Health is also a complicated concept, it can be a moving target and different people will have different definitions and relationships to health. For example, the concept of health will be different for someone who was born with a chronic condition, than someone who was diagnosed later in life, than someone who never has a chronic health condition. When we talk about health we should be focusing on bringing down barriers, improving access, improving social determinants of health, and respecting individual people’s choices.

Health is not an obligation

Nobody owes anybody else “health” or “healthy behaviors” by any definition. People are allowed to make choices that not only don’t prioritize their “health” (based on whatever definition someone is using,) but that actively put their health, up to and including their lives, in danger.

I know that because I watch the Olympics, and there is a sport called Skeleton wherein you travel down an ice chute at 80mph on a sled…face first! This does not prioritize the health. The NFL is built around athletes risking their short and long term physical and psychological health in the hopes that their team will one day score enough points to win a shiny piece of jewelry. Again, they are allowed to do this, but it certainly doesn’t prioritize their health and they are cheered and praised for it by millions of fans (many of whom would suggest that fat* people don’t deserve healthcare because they “don’t prioritize their health”.)

(Those who want to make a “but my tax dollars!” argument can check out this post.)

People use this idea of “fat people not prioritizing our health” as a justification for their bigotry and poor treatment of us, including denying healthcare, while being completely fine with thin people who behave in the same ways that they assume fat people do. 

Health is not a barometer of worthiness

It is completely inappropriate to use health to judge people. People who have health issues should be given shame-free, blame-free, future-oriented accessible evidence-based treatment options. They should not be judged or asked to prove that their health issue is not somehow “their fault” because that leads down a very dangerous road. This is another area where sizeism, healthism and/or ableism can intersect.

It does not matter what size someone is, or the reason for their health status, or what their habits are, everyone deserves to be treated with basic human respect, and with ethical, evidence-based healthcare. 

Even if someone believes that simply existing in a fat body is a health issue (though the evidence doesn’t support it,) there is no health issue that should cause someone to lose the right to ethical, evidence-based healthcare.

Health is not completely within our control

Health is multifaceted and includes genetics, environment, stress level, access to healthcare, behaviors (food, movement, sleep, etc.) social determinants of health, and more. Nobody is completely in control of all of these factors, and increasingly experts suggest that we are vastly overestimating the amount of control we have over our health outcomes.  The number factors that each of us has control over varies depending on factors like socioeconomic status, ability to access care, experiences of oppression including racism, ableism, ageism, transphobia, homophobia, fatphobia etc., effects of events that happened in our past, and more.  The job of public health should be to remove barriers and increase access. The current model of public health too often tries to make fat people’s health the public’s business. That’s not just ineffectual, it’s harmful.

Health is not guaranteed under any circumstance

This is really an extension of the fact that health is not completely within our control. No behaviors guarantee a specific health outcome, people get all kinds of illnesses regardless of their behaviors or body size. Thin people get all the same heath issues that are correlated with being fat, so being thin cannot be a sure preventative or a sure cure.

When it comes to discussions of health and fat people I think it’s very important to make a distinction between the civil rights movement of Size Acceptance, and the paradigm of weight-neutral healthcare.  Most importantly, fat people have the right to exist and to be accommodated, including in healthcare, without without shame, stigma, bullying, or oppression regardless of why they are fat, what the “health impacts” of being fat might be, or if they could/want to become thin.

So one last time - health is an amorphous, multi-factorial concept that is not an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstance. We should keep our focus on removing barriers, providing access, and respecting individual’s priorities. (And while we’re at it, the same goes for “fitness” by any definition.)

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More Research

For a full bank of research, check out 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 Harrisons Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.