Fat activists on the offensive in war on obesity

Poster girl Beth Ditto. Dan Taylor

Obesity is commonly regarded as one of the most significant threats to health in the developed world. It is strongly linked with cardiovascular disease, Type 2 diabetes and impaired mobility. Governments and respected professional bodies have issued reports and warnings on the issue and the World Health Organisation has suggested that 2.8m adults die each year as a result of being overweight or obese.

The dominant medical opinion is that obesity is unhealthy. In the US, where the proportion of adults who are extremely obese (at least 45.4kg overweight) has risen to 6.3% from 1.4% in the late 1970s, it was recently classified as a disease.

It’s a global problem, with Mexico recently taking over as the world’s fattest country.

But as the “war on obesity” rages to prevent, manage and treat the condition, there’s another side in the fight: self-proclaimed fat activists.

Fighting their corner…

Despite the dominant medical view, a large number of people are fighting back. People who broadly identify as “fat activists” (“fat” is preferred to “obesity” as the latter makes the concept inherently medical, which activists believe it shouldn’t be) are challenging commonly held views on obesity, downplaying health concerns and arguing the fact that people come in all shapes and sizes should be celebrated.

Fat activists have diverse beliefs. Dr Charlotte Cooper, a psychotherapist and fat activist, describes the differences between clans in her blog - for example over the definition of fat activism or how to create social change and fight oppression.

But there are common themes: fat activists tend to argue for size-acceptance, and claim that the emphasis on obesity as an indicator of health is misguided. They also question the health benefits of weight loss and suggest that long-term weight loss isn’t possible for the majority of obese or overweight people.

Movements such as Health at Every Size have developed followings who believe that weight loss shouldn’t be the aim but instead a focus on promoting healthy behaviour, intuitive eating and size acceptance to bring about better health outcomes.

Some fat activists suggest the war on obesity is actually being driven by the hugely profitable weight-loss industry rather than good science, and therefore promote the idea that overweight or obese people shouldn’t try to lose weight.

Scientific doubts

Some would like to dismiss this as conspiracy theory but it is important to not accept the dominant obesity discourse uncritically: if fat activists have good evidence for their position, this should be assessed and taken seriously.

The problem is that there is seemingly some scientific support for both sides of the argument: some papers suggest obesity increases health risks, whereas others suggest it may be beneficial. There is obviously a need for more, well-designed research into the effects of obesity - but the bulk of current research and medical opinion points towards obesity being bad for your health.

Obesity stigma

The reasons why obesity is associated with poor health aren’t necessarily simple. The war on obesity, coupled with possible misconceptions about the causes of obesity, has led to significant levels of obesity stigma. This may include perceptions that obese people are lazy, non-compliant, and lacking in self-discipline. Not to mention issues around gender and what is perceived as beautiful in the mainstream and what isn’t, which is a strong thread that runs through female fat activism.

This sort of stigma may result in disadvantages in various areas of life, including education, employment and health-care. Apart from being unjustified, these sorts of stigmas may just be plain harmful. While some people may argue that weight stigma is a good way to prevent obesity and to promote health, evidence suggests that the opposite is true. Stigma has been shown to have a negative impact on health. Stigmatising and discriminating against obese people will not generally make them healthy - or thin.

Fat activism - harmful potential

Fat activists have got some things right by trying to remove any negative connotations from obesity, but they also risk putting the blinders on an unhealthy condition that becomes normalised, accepted and untreated. A balance must be struck between allowing currently obese people to live lives unburdened by prejudice and stigma, and promoting the medically desirable aims of obesity treatment and especially prevention.

Unjustified weight-based discrimination and stigma is clearly wrong, but this doesn’t mean that it is right to view obesity positively. As a crude analogy, stigma associated with having cancer would clearly be wrong, but does that mean we should view cancer positively?

The smoking industry famously denied the health risks of smoking, despite masses of evidence and medical consensus. This is now regarded as a moral abomination. Now, despite much medical consensus on the harms of obesity, a group of people are downplaying the harms, promoting size-acceptance and discouraging obese people from attempting to lose weight. If it gathers sufficient pace, this movement could give rise to a generation who are unfortunately apathetic to the fifth leading risk factor in global deaths. Stigma is one thing but it’s misguided and wrong to prevent others having the chance of better health.