On Medicalised Fat-Shaming

Content note — this blog post contains discussion of weight, diet, fat-shaming, and possibly eating disorders. People who find such discussions upsetting should read no further.

There has been a lot of coverage of the fact that Tom Watson, the deputy leader of the Labour Party, has managed — or claims to have managed — to bring his type two diabetes under control with diet and exercise. This is, of course, an excellent thing. I have no great love for Watson, who I despise as a politician, but I also have no wish to see him suffer from a debilitating disease which can cause a huge amount of pain and suffering.

What isn’t so good, though, is the sheer amount of fat-shaming and abuse of fat people that has come about because of this. “See? This privileged rich white man with a huge number of advantages has managed to make his health better by diet and exercise! There’s no excuse for anyone else!”

In particular, there’s been a lot of sharing of his story to “raise awareness” of how fat people are just killing ourselves because we’re lazy and worthless and useless.

If you’re one of the people sharing this story, think for a second…think about how aware fat people already are of the health problems associated with being fat, and of the fact that we are fat.

Now, there is a lot of controversy, actually, over the relationship between weight and health. Indeed, I have seen several studies which tend to suggest that the increased risk of mortality associated with obesity is actually because of stress, rather than because of weight — fat people are more stressed than other people, and so we tend to suffer more from stress-related illnesses. Put that to one side, and with it the idea that merely by contributing to fat stigma you are also contributing to the deaths of the people you claim to want to help. Let’s just assume, for the sake of argument, that all fat people, if they got their BMI (another very dodgy idea, but…) down to “healthy” levels, would have… ooh, let’s say another twenty years of life.

If that was the case — so what?

What good would that information do?

Because here’s the thing — there is not a single fat person in the world who has consciously chosen to be fat. Not one. Many fat people now choose — or try to choose — to be happy with the bodies we have, but I don’t know a fat person who hasn’t struggled with their weight, who hasn’t dieted, who hasn’t got an immense set of mental health problems surrounding their weight. Such a person may exist, but if those were the only fat people around, there’d be no “obesity epidemic” to “deal with”.

Because here’s the thing that all fat people know, and that no thin people seem to: Diets. Do. Not. Work.

I have been fat all my life — and I mean all my life. My mother tells a story of the health visitor seeing me when I was a baby and saying “what have you been feeding him on, elephants’ milk?”. I remember when I was three years old, crying because the other kids in nursery school were bullying me because I was fat. Whatever caused me to be fat, it was something that I had no control over, unless you think that a three-month-old baby is capable of making life decisions that can affect him forty years later.

I spent all my childhood and teenage years trying to get myself thinner. I used sweeteners in my coffee and drank diet drinks all through my teenage years, and all that did was give me horrible migraines for most of that time. I would regularly go on diets, and nothing would happen.

I did once manage to lose weight. When I was sixteen. For three months I ate a single can of Irish Stew a day, totaling about four hundred calories, and walked sixteen miles a day. After those three months, I had managed to get down to the high side of “normal” — I was still a bit podgy, but at a “healthy” weight. Within two years of coming off the diet and returning to normal eating, I was back to being fat. I could, possibly, have stayed that weight by carrying on eating a single can of stew a day and walking twenty miles every day, but when you do that long term that’s not called a diet, it’s called an eating disorder, and given the choice between being fat or dying because of a lack of essential nutrients, I’ll choose the former.

I tried various diets throughout my twenties and much of my thirties, too. Some caused some slight weight loss — mostly no-carb diets — but none caused any significant long-term weight loss, even when I stayed on them.

And this is not unusual at all, because — short of invasive, complicated, surgery — there is no such thing as a weight-loss intervention that actually works. Studies have shown that ninety-five percent of people who go on diets end up weighing more after five years than they would have if they hadn’t gone on the diet. Yes, you read that right. Nineteen out of twenty people who try to lose weight, no matter what the diet, end up putting more weight on. Not immediately, but in the medium term, trying to lose weight makes you fatter.

Yet if you go to see a doctor while fat, that is what you’ll be told to do — and it’s the *only* thing you’ll be told to do. I’ve been told to lose weight in order to treat work-related stress, or because I’ve had an ear infection. You go to see a doctor and you’re fat, even if you’re not *wildly* fat (and in my case I’ve got a big gut and a large frame, but I’m not the fattest person I know by a long way) and that will be the only thing they look at. My arthritis went undiagnosed for five years because when I went to see a GP about the initial symptoms I was told they were because of my weight (they’re not — they’re because I have psoriatic arthritis, and are the absolute classic initial symptoms of that disease, which one in three people with psoriasis get. As my GP knew I had psoriasis, that would have been the first thing they checked for — *if* I’d been “normal” weight).

As far as I can see, the whole problem here is that being fat is treated like smoking — a behaviour which is chosen by the person in question, and which can be overcome with enough willpower (whatever *that* is, but that’s a whole other can of worms). But it’s not like that. In my experience, it’s more like male pattern baldness, which is something else I have. I didn’t choose to have a giant pink patch of skin on the top of my head where previously I had thick, long, curly hair, and all things being equal I’d rather not be going bald, but there’s absolutely nothing I can do to prevent it. There is, however, a multi-billion-pound industry devoted to conning insecure men who are going bald out of their money in return for the *hope* of getting their hair back.

If someone were to prove to me tomorrow that going bald doubled your risk of, say, skin cancer, I’d say “oh shit, that’s worrying, I hope I don’t get it”, but what I wouldn’t do would be to try to will my hair to grow again in the hope of avoiding cancer, because that would be ludicrous. Nor would I go around telling other bald people “if you just had some self-control you could grow hair”, or talking about how the NHS needed to stop treating bald people because they were a drain on taxpayers’ resources.

I repeat what I said at the start. No-one chooses to be fat. No-one — absolutely no-one — in our society is unaware of the health risks associated with their weight. And far people are *hyper*-aware, because we’ve been bullied about it throughout our lives (or since becoming fat in adulthood, for those for whom weight gain was associated with a hormonal change or similar).

The problem is that the rest of you, the adipose-deficient, are *unaware* of what it’s actually like living as a fat person, what it’s like being fat and trying to access medical help, what it’s like being fat and trying to keep oneself healthy when the *only* advice you can ever get is related to something that you have no control over, and to be constantly bombarded on all sides by messaging that says that if you don’t control this uncontrollable aspect of your body you are subhuman. (For example, do you think that the body-shaming message I’ve had literally every day of my life, telling me that my body is putrid and disgusting and unattractive and ridiculous and should be mocked at every turn makes me *more* likely to go to a gym, take my clothes off in front of strangers, and go and exercise in revealing clothes in front of other strangers? Because it doesn’t…)

And this is me as a cis het man talking. I don’t have anything like the pressures on my appearance that women do, or men who have sex with men. I can’t even imagine what fat-shaming does to them.

“Raising existence” of us as a “problem” is the last thing you would want to do if you actually cared about our health. It just adds to our stress levels and encourages doctors to treat all our medical problems as being caused by our fatness.

So it’s very simple. If you actually care at all about the health of fat people, stop talking about “the obesity epidemic”, stop talking about diets, stop talking about weight-loss at all, for anyone, in any circumstances. Fat-shaming *does not work*, unless the reason you’re doing it is to make people who are already having a hard time feel miserable and unattractive and to hasten their deaths.

The applicability of this to other groups who are also in the news at the moment is left to the reader.

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One Response to On Medicalised Fat-Shaming

  1. po8crg says:

    There is, of course, a very simple explanation of the so-called obesity epidemic.

    Access to food. Until somewhere around 1960 in the UK, most people did not have enough to eat. If you cannot physically eat more than 1000 or 1500 or 2000 calories a day because there isn’t any more food than that, then you’re not going to get fat unless you have an extreme metabolism like Andrew’s – especially if you’re doing a job involving hard physical labour, which was much more common back then. There aren’t many people with primary malnutrition any more (certainly many fewer than in the 1930s, for example). If you’re primarily malnourished, then you can’t get fat, by definition.

    Curiously enough, if you look at the upper classes, who have always had enough food, you find that there were a lot of fat people from as far back as there is any sort of record. Take a look at England’s Kings and Queens. Lots of fat ones there.

    Yes, there is a correlation now between poverty and weight – rich people are less likely to be fat, but not very much less, and the evidence is very weak on why (rich people consume slightly more calories on average than poor people: perhaps it’s access to and time for things like gyms and personal trainers and the like rather than diet?).

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