America’s public health establishment has made a lot of critical mistakes in recent years. One of the worst has been its willingness to comply with social justice activists who are committed to minimizing or denying the dangers of obesity. LiveStrong, a website dedicated to providing “trusted health, nutrition, and fitness information,” offers yet another example of a generally reliable source that has prized current political trends over its science-based mission. Our evidence comes primarily from a May 1 article titled What ‘Fatphobia’ Really Means, and Why It’s So Harmful:
“Weight bias (or what many people think of as ‘fatphobia‘) perpetuates the belief that people who have overweight or obesity are lazy, lack will power and even have low levels of intelligence.”
Keep two observations in mind as we scrutinize this confused article: while nobody should be mistreated because of their size, obesity is a serious health condition, and it’s significantly (though not solely) influenced by what we eat and how much we exercise. Nothing LiveStrong can say, no amount of postmodern claptrap will negate these basic medical facts. Physicians and researchers can’t lose sight of this established science as the message of “fat acceptance” gains more traction in our culture.
Use these words, not those words
Let’s begin by pointing out that fat acceptance advocates don’t agree about which terms are acceptable when describing overweight people. LiveStrong quoted obesity medicine physician Fatima Stanford, who asserted that “The word fat itself is very inflammatory.” In contrast, BuzzFeed, another prominent champion of fat acceptance, recently claimed that “There’s nothing wrong with ‘fat.’ The word itself is just a descriptor.” However, medical terms like “overweight” and “obesity” are off-sides, BuzzFeed asserted, because people use them to give their “anti-fat bias” a veneer of scientific legitimacy.
This may seem like nitpicking on my part, but the contradiction here reveals an important point. Fat acceptance advocates aren’t primarily concerned with which words we use; their goal is to undermine (“problematize” in woke speak) the commonsense conclusion “that fat people could (and should) lose weight,” writes self-styled “fat activist” Marilyn Wann. If you embrace that old-fashioned idea, “your approach is aligned with ‘obesity’ researchers, bariatric surgeons, public health officials who declare ‘war on obesity,’” she adds.
LiveStrong seems to simultaneously endorse and reject this alternative view of obesity. Its website includes an entire section dedicated to “weight management” while also featuring this sort of commentary:
One way advocates for the rights and wellness of larger people try to neutralize that stigma is to describe themselves and others using a term that has historically been a slur: fat. “There’s a fat acceptance movement,” says Lindo Bacon, PhD, a Wayne, New Jersey-based nutritionist and physiologist … It’s basically people saying, ‘We’re fat, we know it, but there’s nothing wrong with it.'”
So, here’s where things stand so far. The fat acceptance gurus are rapidly deconstructing the evidence-based conclusion that obesity is an unhealthy and largely preventable condition. LiveStrong wants to be an “ally” to these activists, for example, by urging health care providers to avoid “stigmatizing terms such as ‘unhealthy weight,’ ‘obese,’ ‘morbidly obese’ and ‘fat.” But LiveStrong also wants to help its readers “reach or maintain a healthy weight.” Contradictions abound.
The middle ground: obesity as a disease
The public health establishment has tried to alleviate this tension by reframing obesity as a disease instead of “simply a lifestyle choice or a consequence of behavior,” LiveStrong has previously claimed. If overweight people suffer from impaired metabolic pathways that distort their hunger and satiety signals, Stanford argued, then blaming overeating isn’t always a viable solution. She drew support from the American Medical Association’s (AMA) 2013 decision to classify obesity as a condition “with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”
That’s a perfectly justifiable definition, though it doesn’t prove what fat acceptance “allies” need it to. By way of comparison, the AMA and other medical authorities have recognized addiction as a disease for many years. But that hasn’t changed the fact that addiction also has a behavioral component. Nobody in medicine lobbies for “smoker acceptance,” for example. Anti-tobacco groups and health agencies explicitly call for policies that restrict smoking in public places and limit the sale of cigarettes. Their goal is to change the behavior of nicotine-addicted smokers by making their habit increasingly difficult to maintain.
A similar case can be made for obesity. For example, weight-loss plans customized to individual concerns and preferences help many people make healthier choices and thus slim down. Research has also found that individuals can lose weight and keep it off by monitoring their caloric intake, body weight, and regularly exercising. Planning meals has the same positive effect. Finally, choosing the right diet is also very important because people often see similar outcomes on very different eating plans.
These results provide clear evidence that individual choices and lifestyle factors are crucial to addressing unhealthy weight gain. Some physicians have even opposed efforts to pathologize obesity because these measures are effective preventative tools.
The larger point is this: classifying obesity as a disease fueled by genetic and environmental factors doesn’t excuse unhealthy behaviors. Instead, it emphasizes that people prone to gain weight can and should work harder to minimize their obesity risk. The UK’s National Health Service adds that “there’s no reason why most people cannot lose weight,” despite the influence of genes and “poor eating habits learned during childhood.”
I’ve written about my struggles with obesity. I’ll be the first to admit that losing weight is difficult and overweight folks are often mistreated by the people in their lives. That said, we can be decent to our neighbors, whatever their physical characteristics, and recognize that they engage in harmful behaviors they should give up.
That sort of balanced approach is how you really demonstrate your interest in someone’s well-being. By contrast, utilizing postmodern gobbledygook to deny the dangers of obesity undermines science and, more importantly, puts overweight people in harm’s way. That’s the cruelest thing you could do to anybody.