12.13.2010

A new conversation: fat and health

In my last couple of posts I've been looking at the backlash Fat Acceptance often faces. A common "stray fattie" charge is that fat activists are in denial about health concerns. Basically, they are so certain in their righteous that we don't merely disagree but are in denial. The fairly broad "nuance" of what Fat Activists actually are saying is irrelevant to them. We disagree with their assertions so they declare we are claiming the exact opposite of what they are. That fat is the paradigm of good health just as they claim thinness is.

They aren't interested in discourse, but rather enforcing the rules the powerful have set for our social conversation about health. We will never win playing within their rules, because their rules already dictate the outcome. That's why they want us to play by their conventions and dictates. Their conversation about fatness only allows one outcome and this enables them to distort our claims as they try to force them into their guidelines.

What Fat Acceptance must do is forge a new conversation. I think we see a relation to this in fretting about "good fatties" and "bad fatties". That moral dichotomy is informed entirely by the rules of fat hatred. They've decided we are bad. We will never be able to prove our "goodness" within their rules, but likewise we will never be able to excuse our "badness" either. I honestly haven't seen a fat activist suggest the former, that being "good" fat people was a solution but I have seen the later where activists bristle at discussions about so-called "good fatties" preferring to argue that health is not a moral imperative. Neither, though, would be effective although both speak to a truth that I think could be our key. We need to tear down the conventions which confine us in order to start a new conversation about fat health. We can't play by their rules, but we can't deny them, either. We need to confront them to dismiss them so we can move forward.

In the comments of this article, Silentbeep made a very astute observation about why we talk about so-called "good fatties". The point is not to exault them but to demonstrate "health variance when it comes to fatness". The current rules to discuss fat and health deny this. There is one outcome. One option. We need to show that this is a sham, that how they are defining health is functionally flawed. "Good fatties" aren't playing by the rules, they are invalidating them.

But this isn't an end. We need to move past this lest we be offered defensive indulgences where we are "allowed" to be fat so long as do all the "right" things. Its not about winning acceptance on their terms but completely revolutionizing what we understand to be right. And that means refusing to promote health as a moral imperative.

Fat activists don't deny that fat can impact health. We deny the conclusions drawn about that. Both about individual health and about personal morality or responsibility. Fat people have unique health concerns that need to be addressed. The issue is that our current system doesn't do that. It fails the health needs of fat people by insisting on stigmatizing fat and promoting failed treatments that do nothing to address one's health. They say that fat activists don't care about the health of fat people, but I say that's 100% false. We DO care about the health of fat people and that's why we demand better than futile weight loss dieting. They've had decades to enforce their views and its done nothing. We need to stop this and start finding ways to serve fat people's health needs with respect for their body. Not with an insistence that the body change before you start caring. That's not the conversation they want to happen, but its what must happen.

It isn't wrong to be fat and have diabetes. It isn't wrong to be fat and have high blood pressure. It isn't wrong. It just is. And we need to demand treatments that address what is an issue instead of trying to change our body into something else. Not only does this ignore what's actually going on, it doesn't work. We need to say that and demand better. We need to demand a new conversation.

Shame isn't a very useful tool in improving health to begin with and its utterly perverse that we shame people into treatments that will fail them. A dieter who regains the weight lost is not a failure. Those results ARE typical and is our cultural dictates on fat and health that are failing them. It needs to be okay to talk about how we are "good fatties" as well as how we are "bad fatties". Because this isn't about good vs. bad. This is about something different, something new. That is the conversation we need to have.

17 comments:

silentbeep said...

Yup a thousand times! The way we talk about health currently, the mainstream established way, creates a painful, dehumanizing false dichotomy between "good" and "bad" fatties. It's all b.s. actually because there is NOTHING wrong with being a mortal, human being that gets sick. This goes deeper than fat acceptance - this goes into a really, oppressive way of thinking about health, for everyone, that causes so many people to think "it's all my fault if I'm not well, and I'm a moral failure if I don't do these things that everyone says are healthy." That's just crap

"We need to demand a new conversation." Amen.

"That moral dichotomy is informed entirely by the rules of fat hatred" Exactly. And I'd love that dichotomy to be smashed to bits, because it's based on the rules of fat hatred. I don't want to play that game anymore.

Brian said...

The whole "good" and "bad" thing is purely looking at the discussion coming from fat acceptance from the perspective of the cultural moral dichotomy as opposed to something from within FA. But while we talk about "good fatties" what we're actually talking about is how meaningless these supposedly moral distinctions are. Because a good fattie is a contradiction in terms to the conventional discussion and THAT is the point. Not that we can play by their rules but that their rules are bullshit.

joannadeadwinter said...

I confess that I am one of those activists that really goes on a tear when I hear people respond to concern trolling with long lists of healthy behaviors that the fat person engages in, usually with a hefty dose of healthist language and tone. It's a huge trigger for me given the shaming that I have been subjected to in the past for not being athletic. I have had health problems over the years, and you wouldn't believe the unsolicited medical advice I get because others have taken it upon themselves, without my permission, to "look out for my health."

I still agree with everything you've said here. I wrote on my own blog that a time-tested propaganda formula is to demonize oppressed groups by making them out to be diseased. This makes discussions of fat health a crucial aspect of challenging the anti-fat establishment. It also is an option for fat people to improve their quality of life in a world that thinks they deserve NO life, much less a quality life.

What's important to remember is that FA and fat health are separate, although related. FH is part of FA, but not the whole of it, nor the most important part of it. When discussing health, our conception of health should be holistic so that those who cannot or will not meet the conventional definition will not be left out. During discussions that are not specifically health-related, we need to include all fat people by keeping in mind, when we write, that not all fat people are or are trying to be healthy. This means avoiding the use of healthist language and tone.

As far as concern trolling is concerned, that is where I draw the line. A troll is a troll, and the only proper response to them is to reject them totally and explicitly. When you respond to healthist comments with a novel about your diet and exercise, you are playing by their rules. And I can't tell you how many times I have tried to start a discussion about healthism only to have a troll show up and the next thing you know, everyone's busy arguing over what's healthy and what's not and everyone bragging about how healthy they are.

I get the whole part about breaking stereotypes, and that's crucial. I get the part about improving fat people's options and quality of life. The problem is that we are activists fighting for bodily autonomy and respect, and healthism is both pervasive and virulent in our culture. That means we need to be all the more vigilant in avoiding the healthist trap and creating a safe space for all fat people, healthy and unhealthy, and with all different ideas of what health should be.

It's a tight balance, but it can, and should, be struck.

joannadeadwinter said...

I'm not sure if my last comment made it through, so I'll try again just in case.

I'm one of those activists that raises hell whenever I hear discussions about fat health. Because of my personal experiences with shame over not "behaving," not being athletic, and getting unsolicited medical advice for my health problems, it all sounds like healthism to me and it's a huge trigger. I also have to say that it's rare for me to start a discussion on healthism and NOT have a troll show up and for the whole thread to turn into a debate over what's healthy, what isn't, and whose doing a better job at being healthy.

That said, you're absolutely right about this issue, and discussions of health don't have to be exclusionary. Health needs to be discussed because part of removing barriers for fat people includes demolishing stereotypes. It's even more crucial for fat people to have options to improve their quality of life, because any other advocacy and self-advancement is next to impossible otherwise.

When talking about health, we need to be careful about avoiding healthist language and tone and have a holistic idea of what it means to be healthy. No one should have their options for quality of life limited because they can't or won't meet the conventional standards. Just like we all have different bodies and lives, we all have our own health needs.

When not talking specifically about health, we need to keep in mind when we write that not all fat people are, or are trying to be, healthy and to include all fat people. Avoiding healthism is even more important in this context, and it's so hard because healthism is so pervasive in our culture and part of our job IS to demolish stereotypes of what fat people are, which includes the stereotype of fat people who totally neglect themselves. It's a balance that needs to be struck.

As for concern trolling, that is where I draw the line. If someone shows up with "concern" for our "health," that is NOT the time to break out proof of gym membership/Whole Foods receipts. That's the time to reject them and shut them down, totally and explicitly. Trolls are trolls.

Within the FA community, however, we should have this discussion, but like you said, we need to conduct it differently and on our terms. This will not only include all fat people, but open people's minds to ideas of well-being they might not have thought possible. That's what happened for me, and it helped me to feel less triggered by discussions of health.

Brian said...

We absolutely need a more expansive understanding of what "healthy" means. I think when we talk about experience that show a fat person who is "healthy" on the terms of the cultural understanding, its showing a way towards that kind of expansion. Its showing that this narrow construction is wrong and we absolutely shouldn't just stop there. We should question the whole of healthism because we're never going to bargain with it. Its a folly to try to curry dispensations for being fat. We need to raze the whole system and start anew.

I do think refutation can have a place in that, but there needs to be that follow-through. Prove the troll wrong when they are wrong, but make it clear that this is not negotiation. When they are wrong, they should be told so but we have to press that advantage and call their whole system into question.

It gets back to show that variance in fat health. I don't believe there even are these ideals of good and bad fatties. All of us have a foot in both camps. There are ways I'm "good" and ways I am "bad". That's why I reject the whole notion of these being distinct constructs. My morality is not defined by my health.

rhondaroo said...

The insurance industry, the fashion industry, the exercise industry, the weight loss industry, and the United States government are involved in stigmatizing and scapegoating fat people. That is what we are fighting to end. I applaud Brian,all other fat/size acceptance bloggers and activists that are taking up this fight. Why don't we use Judy Freespirit, (I hope I spelled her name correctly), to inspire us.

CaptainRaz said...

Fat Activists DO care about fat people's health. I think the major difference is that the Fat Activists tend to care about mental and emotional health just as much as physical health. I think that's what a lot of people can't get their heads around. Discourse on health usually concentrates on the physical and ignores the mental completely. Certainly the FA people I read regularly will put their mental or emotional health first if need be, and I think that's what a lot of non-FA people struggle to understand.

wriggles said...

Excellent posts, including the ones you linked to. I think this post should be on a 101 link this is the essence of it for me;

We will never win playing within their rules, because their rules already dictate the outcome. That's why they want us to play by their conventions and dictates.

This is what irks me about FA, even this so called "we have the science arguement", really who cares? What about this is about proper science, which is about what you can predict and repeat? If there is anything more predictable than the outcome of WLD, I'd love to hear it.

I think that health is an intensely moral issue. Before germ theory was discovered, well off people felt so bad for the poor living in filth and squalor that they advocated for better conditions.Not long after that they discovered how infection was passed on.

Unless you are affected morally by the condition of your fellow HB, why would you care either way?

Talking about health not being so, again takes healthist view of health when it is a distortion of it. It's really an elitist form of hypochondria which seeks to take health out from within all of us and turn it into an achievement in the far distance.

It weeds virtually everyone out of being truly 'healthy' because it's not about increasing health but trades on half arsed eugenics.

HAES in a way is that it is more like an old fashioned rational view of health and maintaining/improving it, which has to start from where you are.

Basically I don't like healthism, equally the idea that fat people are physically incompetent is highly exaggerated and something that is used to disenfranchise young fat kids from engaging physically.

I think folk should challenge healthism, but they also need to get over this bad fattie crap because defining yourself that way is also healthism.

Brian said...

I think folk should challenge healthism, but they also need to get over this bad fattie crap because defining yourself that way is also healthism.

This a much more succinct way of saying what I think I was trying to say. The notion of good vs. bad, no matter what side you self-identify with, is a problem and it contributes to healthism. We've got to move past that. I think both sides in the internal FA debate on this are right in their own ways. We can't just refute the distorted views about fat people, but we can't try to ignore them entirely.

I'm reminded of the gay rights community's approach to the genetic aspects of sexuality. As an ideal, it should not matter if one is born gay. The discrimination would be wrong. The issue is, it DOES matter to the people doing the discriminating and we can't just make that go away. And since sexuality is innate for evidently most people, its worth stressing that point. Not to win acceptance on narrow terms but to break down the resistance. Once you can show that conventional wisdom was entirely wrong, then you can start questioning the wisdom of the conclusions drawn from it.

We are breaking down a wall. We can't bargain with the wall, but we also can't tell it not to exist. We have to break it down bit by bit. Once we expose the weaknesses, the hope is the wall comes crumbling down.

Anna Guest-Jelley said...

"It isn't wrong to be fat and have diabetes. It isn't wrong to be fat and have high blood pressure. It isn't wrong. It just is. And we need to demand treatments that address what is an issue instead of trying to change our body into something else. Not only does this ignore what's actually going on, it doesn't work. We need to say that and demand better. We need to demand a new conversation."

Fantastic!

silentbeep said...

I want to say this: It feels really ugly, when people tell lies about you, and it doesn't matter what the nature of the lies are. When your existence gets erased as being nonexistant because everyone knows that all fat people are all one way (eating two whole cakes and on the verge of death) it doesn't feel good. I don't think saying this is bargaining, this is telling the truth, and standing up for oneself if that's not your experience.

However, in refuting the lies about fat people being cartoon characterizations of fat, we do need to go beyond that. I agree with everyone here: we have to remove the supposed "right to shame and stigmatize" fat people that don't fit in with what society deems as acceptable in terms of health.

"It isn't wrong to be fat and have diabetes. It isn't wrong to be fat and have high blood pressure. It isn't wrong. It just is" Exactly.

silentbeep said...

Additionally: I don't buy that it's anyone's experience really of "just being so lazy and eating all the time." That's a dismissive way of looking at anyone's experience with just being hungry, binge eating, or disordered eating. That whole thing is just an ugly way of dismissing and shaming fat people for eating, for the most part.
And shaming fat people who need medical care too.

Brian said...

Very good point, silentbeep. Fat people feel such intense pressure to self-judge their behavior as "bad" that I think we get used to being hyper critical of ourselves. I know I go through times when I know I'm doing that to myself. Self-perception on these issues is very much colored by our culture and that's one of the reasons we need to take combine Refute and Reject.

Ruth said...

I am a medical student and I cant help but completely agree (despite a lot of my education saying I should feel otherwise) There is more to health than fat, and the current conversation is failing. My difficulty with some parts of the fat acceptance movement are that in some cases, losing weight will improve peoples health. BUT and it is a very important but, this isnt anything like all the time (or even all that common. The conversation needs changed so that "lose weight" from a doctor is taken as more than a stock response from the medical profession to a sick fat person. Explanation needs to be given. Other options should also be given-say trying to improve quality of life and social support for a sick person. These may indirectly reduce thier weight but they shouldnt be given just for the sake of that.
Fat people avoid doctors due to weight stigma. This means they are sicker when they do come and so cost more and lose more in quality of life. I would say this is more why fat people are supposed to have higher healthcare costs than just due to thier size. At least one good reason for demanding a new conversation. It saves money, prevents sickness and improves quality of life.

Brian said...

Thanks foryour post. I don't think fat acceptance denies the hypothetical person who would be healthier if they hypothetically weighed less. Its that treating people's hypothetical bodies has never been shown to productive on any consistent or safe basis. If we remove fat stigmatization's influence on health, I'd hope doctors will more readily identify how weight can be a symptom of other problems. Weight gain can be a sign of something wrong, but its far too common for it to be responded to with ineffective calls to lose weight. Likewise, a fat person losing weight can be a warning sign, but its often met with cheers. By treating all fat patients with one remedy (and one with a consistent record of failure), our medical establishment is not rising to the challenge of treating the health needs of fat people. We can do better.

silentbeep said...

@Ruth

"My difficulty with some parts of the fat acceptance movement are that in some cases, losing weight will improve peoples health"

And this is the problem here, because what many people don't want to accept or hear is that no matter how much people think "gee that person needs to lose weight" it still doesn't make dieting any more effective in the long run, and it still doesn't make WLS any less risky or any more effective for permanent weight loss. The common "cures" for obesity, dieting and WLS, are largely ineffective at best and mostly make more health problems, at the very worst. Of course there are exception to the long-term "success" rate of dieting and WLS, but that's what they are: exceptions.

Your above concern that I quoted, is totally addressed by this entire post and every comment. Sadly, I think the point has totally sailed you by...

Brian said...

This site is not a forum for attacking fat acceptance or justifying/defending/promoting dieting. Any such comments will be deleted.

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