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Pattie Thomas, Ph.D.

Pattie Thomas Ph.D.

Fat by Choice?

What if fatness isn’t a choice or consequence of choice?

Earlier this month, a news anchor in La Crosse, Wisconsin, Jennifer Livingston, spent four minutes of precious air time responding to a man who accused her of being a bad role model as a public figure because of her size.

His argument that supported his bullying (and that made by many who feel they have a right to comment on the appearance of a stranger’s size) is that Livingston was obviously making a bad choice. He wrote, in part,:

Obesity is one of the worst choices a person can make and one of the most dangerous habits to maintain. I leave you this note hoping that you’ll reconsider your responsibility as a local public personality to present and promote a healthy lifestyle.

The question of choice is really where the whole issue of admonishing people to lose weight resides. IF a person could choose to be NOT FAT, then they deserve the stigma and shame, so goes the reasoning.

Of course, this argument fails on the surface. All humans make bad choices and stigmatizing them for the bad choices is a poor strategy to help them change. In fact, stigmatization is always a poor strategy. Judging other people on the basis of a singular characteristic they share with other people, never creates a full picture of that person.

But setting aside the obvious, the question of fat as choice is an important one.

The “common” understanding of weight is that the only factors that create changes in weight are calories ingested and calories used for activity. This understanding is a very old one and is based upon a nineteenth century view of the human body as a sophisticated machine. Disease, wellness, and treatment or cures in the nineteenth century medical mind is reductive: one cause, one effect. Allopathic medicine revels in this thinking. It is often called “the magic bullet.” If you can isolate the cause and create a treatment that alters the single cause, then you give the treatment and the medical condition is cured, usually via a pill (thus “the magic bullet”).

An incredible profitable multi-national industry relies upon this reduction, often called the pharmaceutical-industrial complex. And, please don’t get me wrong. Twenty-first century people have considerably longer lives because of medications. Since we discovered that organisms residing in our systems can often create diseases and that chemicals ingested would alter those organism so that the symptoms subside and the body returns to normal.

But what we know now is that not all diseases and abnormalities in body functions can be reduced down to one germ, one treatment, one cure.

Chosing, man at sign post with many directions, to be or not to be.

A more complex model is needed and this is where the controversy begins. The Health at Every Size® approach offers a model that allows for variations in weight being natural, and expected as the diversity of human beings has a vast range. If the variation is “normal” then demanding that people choose to be different is like asking someone to change their height. Technologies exist, of course, but why do so other than vanity or attempts to fit in? Certainly we do not expect one’s health to be improved by wearing high heals or lengthening the bones in one’s legs.

HAES® begins with accepting size as natural and suggests that the pursuit for better health is possible for any human. The choices one makes are behavioral. One does not choose to BE FAT as the often heard criticism suggests. Rather one chooses to eat nutritious foods, move often, eat when hungry, finish when full. Theses habits could also include regular check-ups, screenings, vaccines, taking medicines regularly and seeking a balanced and low-stress life. In other words, size doesn’t measure anything. And size is not a choice.

If you do not accept HAES as the correct understanding of weight, there is still a lot of evidence that much of a person’s weight is beyond their control. Genetics, pollution, environmental factors and certain diseases, medical conditions and medications have all been implicated in creating larger bodies. I would suggest that the answer in this particular environment is that bodies at both extremes of the range (very fat, very thin) might not exist if we as a culture were not so obsessed with weight control. Interestingly enough, attempts to control weight also seem to create bigger bodies.

The bottom line is simple: We’ve pretty much tried every way we can think of to control weight and we have not found a way to do so for any length of time. Holding larger people to a standard of choice is antiquated. Admonishing people to make better choices based upon their looks is bigotry, pure and simple. That is why it is bullying. Bullying, even if it is “just” spoken, is harassing someone based on the assumption of a superior position. “I can prove I am better than you by pointing out your flaws.” That is why the email Jennifer Livingston received was bullying and it is why she was right and brave to speak out.

Ironically (and I use the word with a lot of sarcasm), it may be the stigma that is causing the link between health and size. There is still more research to be done, but stigma and health has been linked by a number of studies in the past 30 years or more. Now some researchers think they’ve found a physical response to the stress caused by constant stigmatization that accounts for these correlations: cytokines. It will be interesting to see where this research leads.

In the meantime, what all this boils down to is that commenting on another person’s size is never helpful and may in fact be harmful. It also means that trying to cure a natural variation in humans may be causing more harm than good.

I seem to remember a really old adage regarding health that it might be time to follow: first, do no harm.