A Blog I'm Reading

Tam recently introduced me to the blog Dances With Fat, written by a (once and future?) competitive dancer / activist / self-described "REALLY fat person".  It's a nice introduction to (one person's ideas about) size acceptance and health at any size.

Size acceptance is a civil rights movement making the pretty straightforward statement that the discrimination against and shaming of people on the basis of their body size is wrong and should stop.  Period.  Although DWF mostly talks about fat acceptance (which makes sense given the author's own size and the fact that it's overweight and obese people who bear the brunt of size prejudice), it also makes a point of including all body sizes in this, including middle-weight people feeling pressured to be even thinner and very small people who deal with assumptions about their health and behaviors and get the "eat a sandwich!" comments from people on the street.  There is also a personal side to size acceptance -- appreciating and loving your body, whatever its size, and not letting your size determine your self-worth.

Health at any size is the idea that rather than focusing on body size/weight/fat, people would be much better off pursuing healthy behaviors (e.g., exercising, eating fruit & veg, not smoking) that have an evidential link to important health outcomes, letting their body weight fall where it may.  The basic argument (as I understand it) for this approach to health is:

• Being stressed, concerned, anxious, and unhappy with your body isn't very good for your physical or psychological health in its own right.  This kind of chronic stress is linked to all kinds of bad stuff.  I think the evidence for the chronic stress-unhealth link is quite clear, and I'm not aware of people attempting to make an opposing case.  And though I suppose someone could claim that being unhappy about their size is not actually stressful, I think that basically the entire literature of social psychology says that they're wrong, in addition to all the studies that have explicitly demonstrated this effect.

• Losing weight, and maintaining that weight loss for any appreciable length of time, is practically impossible.  (Yep, there is the whole National Weight Control Registry thing, but that's not very many people -- like 5,000 or 10,000 people -- in the context of the gazillion of people who regain the lost weight.)  And the few people who do maintain a lower body weight typically engage in obsessive behaviors (e.g., extreme calorie restriction, huge amounts of exercise, avoidance of any/all social activities that could involve food) that would be diagnostic of an eating disorder in a person without a history of overweight.  Research is also increasingly showing that the bodies and brains of fat people who lost weight to achieve "healthy" weight X do not function like people who have weight X without dieting -- and these differences are the types of things that make weight regain much more likely.  Some of these differences seem to influence feelings of hunger, cravings, etc., that people can attempt to categorize as individual moral failings, and other differences have more direct effects on weight gain.  My guess is that people perceive dieting as successful because people are able to lose weight in the short term, and when they regain that weight, they see it as a personal failing rather than a failure of the diet.  I think that perspective is mostly wrong-headed -- if the vast majority of people can't get dieting to work long-term then I wonder how useful it is to blame the people rather than the dieting.  But regardless of where one assigns the blame for weight regain, it does strongly appear that long-term weight loss is just not gonna happen for the vast majority of people.  Thus, pining one's hopes of health on (and placing one's happiness hostage to) being a thinner person is not an effective approach.  Doctors, loved ones, etc., who push fat people to become thin "for their health" probably are sort of missing the boat here. 

• The weight yo-yo caused by the weight loss/weight gain cycle is really unhealthy itself -- it's probably worse for your health to keep bouncing between higher weight and lower weight than just maintaining the higher weight.  I'm not as familiar with this literature, but it seems plausible to me that this could be true.  To the extent that it is true, it puts the nail in the coffin of weight loss as a prescription for health.

• Finally, even if people could lose weight, body weight does not have a strong direct effect on a person's health.  This is a claim that I really don't know how to evaluate.  It does appear that some studies find that other things (e.g., healthy behaviors) have a much stronger effect on health outcomes than body weight, but I have also seen other research suggesting that body weight is a better predictor than behavior.  I think that if you're already fat (or whatever weight you are), the evidence suggests that trying to be the healthiest person you can be, without focusing on size, is a good approach.  The question that this "fat doesn't matter" claim brings up for me is, What are the implications of this for people who are not already overweight?  Should people stop trying to maintain their current weight? 

I have spent a fair amount of time reading the back entries on this blog and recommend that if you have an interest in these issues, you will find this worthwhile as well.  I don't claim to be 110% in agreement with her on everything, but it's good, thought-provoking stuff.  Here are some posts that I think make a good entry point to the blog, in addition to the embedded links above:

• Are health at every size and size acceptance the same?
• Health and size acceptance
• What if I'm not comfortable with my weight
• Calling obesity a problem is the problem
• Weight loss not the solution