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Moving beyond weight: Why the focus on size is bad for health

There’s a tendency to believe that only obese people need to be educated about unhealthy and unnecessary foods. Rudd Center for Food Policy and Obesity

Parents in Australia recently made headlines expressing frustration with a health-care system that confuses weight with health.

They’ve been expressing their anger at two related, but separate, offenses. First, their active healthy children are being labelled obese, a term many in the medical and lay community falsely believe to be a disease diagnosis. Second, without being asked about their child’s eating habits and activity levels, they’re being counselled to ensure their kid starts exercising and cuts back on fatty foods, such as whole milk.

Many a fat person can understand the frustration of these parents, as they frequently encounter doctors who refuse to treat fat patients, doctors who refuse to offer any treatment plan except “lose weight” and doctors who regularly shame their fat patients for their fat bodies. You can read stories of fat prejudice in health care in the “First, Do No Harm” blog.

The discourse of the obesity epidemic results in anti-fat attitudes that influence the health of fat people through reduced access to health services, reluctance to seek health care and poorer care from health-care providers.

Fat-o-sphere bloggers have written their own stories about receiving poor medical care. Imagine being a professional dancer who is admonished by a doctor to begin exercising, or having your doctor dismiss the information you provide about your health habits or just call you a liar.

What’s more, how we talk about obesity impacts the health and well-being of all individuals. Health-care professionals are less likely to counsel slim patients about diet and exercise, perhaps falsely believing that they are already engaging in healthy behaviours because of their physique.

Do you know a slim person who eats unhealthy food and never exercises? What about a fat person who exercises regularly and is very careful with the calories they consume? Or a fat person who eats unhealthy food and never exercises because what does it matter when they are already fat and assumed to be unhealthy? What about a slim person who eats unhealthy food, never exercises and never worries about their health because they assume being slim means they must be healthy? Such assumptions are constantly reinforced by our culture.


A viewpoint article in a recent issue of the New Zealand Medical Journal provides an interesting case study for this point. The article features a list of foods that the authors assert are “non-essential, energy-dense, nutritionally-deficient”. Foods such as fruit tinned in syrup, fruit juice, honey, energy drinks, jam, granola bars, sour cream and toasted muesli join the ranks of the regular suspects of alcohol, cakes, doughnuts and ice cream.

The article begins with the usual obesity epidemic hand wringing and concludes by suggesting that fat patients should be warned away from these foods. News coverage continues this logic – obese people must be educated about these unhealthy and unnecessary foods.

This is the usual discourse of the obesity epidemic and it shows how the authors fail to recognise that if foods are lacking in nutrition then all individuals – regardless of size – should be told to avoid them. Why is the focus, understood as prioritising health, directed only at fat people, who are assumed to be unhealthy based on their weight?

We do everyone a disservice when we get wrapped up in the hype of the obesity epidemic. It’s time to move past the language of weight and hate and adopt the language of health, specifically of Health at Every Size (HAES).

HAES is a new medical paradigm that shifts the focus away from weight and back onto health where it belongs. It embodies a weight-neutral approach, and doesn’t support weight loss for its own sake.

Unsurprisingly, there’s confusion about HAES, so let’s clarify at the outset that it doesn’t suggest that every size is healthy for every body. Rather it asserts that every body, regardless of size, is capable of engaging in healthy behaviours. And it is backed up by empirical evidence that finds improved health outcomes are possible independent of weight loss.

Adopting the HAES approach means moving past the discourse of the obesity epidemic. It means we stop talking about obesity and obese people and weight; it means we start talking about what we claim really matters – health.

Moving past the obesity epidemic discourse means focusing on providing access to nutritious foods for people of all sizes; encouraging enjoyable movement for everyone and; ensuring that people of all sizes have access to effective and evidence-based health care.

And it means we have to start talking about something other than what people weigh.

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