Lipid II

I seem to be surrounded suddenly by obesity discussion. I posted on it two nights ago, and suddenly a report comes out which shows an increase in obesity and unhealthy eating, particularly in young people. Hack did a show on it (which I missed, but plan to catch up on).

Spilt Milk very kindly dropped by from her blog to take me to task and pose some interesting questions about my own perceptions of obesity, body image, diet and weight. As usual I began in the comments box, hit Chapter 4 of my response and admitted that this was an issue which required its own blog.

You can read Spilt Milk’s entire response to my previous post in its comments section, but I was most interested in the questions she posed to me and I’ll answer them in sequence here.

Can the majority of people achieve long term weight loss?
This is a yes/no question in which both answers can be successfully argued as incorrect because its parameters are unclear enough to leave open debate. What is meant by “majority”, “long term” and “weight loss”? In fact, given that there is no perfect weight, why focus on loss?

Does attempting to lose weight (dieting) carry health risks?
Yes. Again, if the focus is on losing weight, instead of living healthily, then absolutely yes. But the word ‘dieting’ here needs qualification because it is an extremely loaded term. Technically, we are all ‘dieting’, we all have ‘diets’. However, the word ‘diet’ has come to mean ‘eating less’ or ‘eating plan focused on simply weight reduction as opposed to long term health’. The factor at variance is the quality and balanced of the food consumed.

Is dieting in one's lifetime associated with higher weight?
Again, this question is too broad to successfully give a yes/no answer without qualifying one's response, or clarifying the terms used.
I'm of the opinion that 'dieting' is an old-fashioned, unhelpful word for 'eating' - as old-fashioned and unhelpful as 'fat'. Taken literally, this question asks 'Is eating associated with higher weight?' to which of course the answer is 'yes', even if only because the converse is also true - 'Is not eating associated with lower weight?'
I'm going to assume that the underlying meaning of this question is more specifically:

'Is attempting to modify one's diet purely with the goal of losing weight (as opposed to overall health) associated with long-term, low health patterns; one of the indicators of which can be higher weight, particularly if an individual is already pre-disposed to higher weight?'

To which of course the answer is yes. But the implication of this question is a moral one, pointing towards a negative attitude towards impelling people to change their diets with the singular goal of losing weight. This is a straw man - no one seriously involved in this discussion would agree with telling an unhealthy person to reduce their eating or change their diet purely for a change in body shape.

Is correlation (obesity with diabetes) causation?
No. But correlation can be indication. An indicator (obesity) is more useful than a cause in this discussion because it is given equal relevance to a discussion on health to other indicators (of diabetes, for example) and can also be addressed as part of a health plan, rather the focus of it. The removal of cause also removes blame, which I believe is one of the primary reasons for FA or HAES activism.

Does social isolation cause health problems?
This is another straw man, the implication being that without a FA or HAES societal attitude, people are given the unwelcome choice between the documented health problems caused by unhealthy attempts at weight loss and the documented health problems caused by the social isolation currently visited upon fat people.

Is a 'personal responsibility' approach the best to take towards public health problems?
This is one I can't answer. Public health is a really broad area, and by definition, not personal. Hand washing is a public health issue, but requires personal responsibility for its function to succeed. Ditto immunisation.
I'm not sure obesity is a public health problem, but it can have public policy implications (increased need for treatment for ailments indicated by obesity, etc), but this is a democracy and that's what we pay our taxes for: to help each other.

What percentage of obese people are the obviously fat, 'morbidly obese' size?
(I'll answer that one - it's about 6%. The vast majority of people counted in obesity statistics are not considered very fat by societal standards.

Check out the BMI gallery at Shapely Prose to see what I mean).

I guess what I'm saying is that many assumptions underpinning 'mainstream' beliefs about fat and health can be proven wrong or at least a little wobbly. Always great to have people join in the conversation :)

I guess what I'm saying is this that in order for the whiff of denial to be eradicated from this discussion on bodies, these types of questions and implications need to be respectively answered and avoided.

More to the point: medical discourse surrounding weight is results-focused. It simply does not have the complexity or depth to take into account the lived experience of existing in a body which it has termed to be insufficient. Medicine is purely a science. Science is based on quantifiable results, not the external realities of how those results are interpreted and utilised. Science cannot predict, explain or treat some dickbrain screaming 'You ate all the pies!' from their car window at a diabetic.

But I’m still wondering: in a Fat Acceptance or Health At Every Size disourse, can obesity or even body size can be discussed at all? Is discussing ours and each other’s bodies out completely?


Elephant In The Room: This is the one I'm not qualified to discuss, but cannot move forward without addressing. Fat is a Feminist Issue. I'm a man. The experience is and will always be different. This doesn't mean I should bow out of the discussion but it needs to be acknowledged that most of the discourse surrounding health and weight is carried by women. Before we start making rules about how obesity and weight should be discussed, it needs to be acknowledged that men's bodies and women's bodies are treated differently in our culture and so the solutions and strategies for Fat Acceptance and Healthy At Every Size activism need to take that into account - something which I'm yet to see happen.