On Fat Acceptance and Denial of Risk

Since coming to my decision to have weight loss surgery, I’ve also been painfully aware of what I say or how I express my opinions about weight related matters. The last thing anyone wants to turn into is “that person” who finds a new mantra and is suddenly the world’s foremost expert and evangelizer for their newfound life choices. I fully admit that WLS is not for everyone, and even if it would be a good solution for an individual – it’s not the right solution for them until they are in the appropriate mental headspace for it. Sometimes that point can be reached with a short period of education, or it may take months or years to work through the denial and finally acceptance that has to come with it. 

Now – deep breath – that all said: sometimes the answer to health problems really is “you need to lose some weight”. Unfortunately that’s not a statement that many people want to hear. Even more unfortunately, it’s a statement that a growing portion of the population is rejecting out of hand as “sizism” or “fat shaming” on the part of the public and even the medical community. Weekly I hear tales of people refusing to follow sound medical advice if any portion of that discussion has included the phrase “if you lost some weight…”. 

Before anyone picks up the pitchforks – or for those already armed, before you start swinging them at me – I fully recognize and acknowledge that some members of the medical community either over-focus on weight or have poor enough patient communication skills that their valid points get lost in the talk about weight management. They are out there. They are not, however, every medical practitioner out there, nor I would say, even the majority of medical practitioners. 

I’ll go ahead and put it out there that I think the root of many of these reactions from heavier patients can be found in the loosely defined “fat acceptance” (FA) movement. The idea has been around for decades – that no one should be discriminated against based on their size. Oh baby, am I all for that idea. I was no less mentally capable or intelligent or less skilled in my work when I (barely) wore a size 28 than I am today in a size 12. Luckily my current profession doesn’t require significant physical abilities – as long as I can sit at a desk and work on a computer 40 hours a week, whether I can do push-ups, lift 50 pounds, or run 100 yards in a sprint is pretty irrelevant. 

Where FA falls down in my opinion, is when it moves beyond the idea of non-discrimination, and that people of any size should be able to feel good about themselves and comfortable in their own skins, into activism or dogma that promotes the idea that fat is healthy. No. No, it’s not.

"Fat as healthy" activists claim that an individual can be both “metabolically healthy” and fat.  Metabolically healthy is defined as having standard measures of blood work and screenings for high blood pressure, diabetes, and other diseases often associated with obesity coming back “normal”. It can happen. In fact, I used to be one of those people. I consistently had blood pressure of 110/70, no indication of diabetes or insulin resistance, and had lung capacity that was better than many people who did physical work for a living – and I weight 250-300 pounds. 

Where the idea of  “metabolically healthy and fat” starts to fall apart is that it only looks at that one snapshot of time, with no acknowledgement of risk factors – obesity related or not. The proven facts are that being obese increases a person’s chances of developing heart disease, diabetes, and other life-shortening illnesses considerably. The scientific literature is pretty damned sound on this point.

Now nothing in this says that “normal” weight or “skinny” people don’t have risk factors for heart disease, or that only obese people get diabetes. I’m not arguing that in any way. But the risk factors are consistently higher when you are obese. 

Beyond metabolic issues is the wear and tear that obesity takes out on your body. Despite being athletic before gaining weight, and being able to do quite a few things with great cardiac response at my current weight (I just passed a stress EKG with flying colors), I was diagnosed with pretty significant osteo-arthritis in my knee after an injury just before New Year’s. It’s clearly been building over time per the orthopedist, and at this point can only be managed – there’s no reversing arthritis. I’m not unduly restricted in what activities I can participate in, but I was encouraged not to try and run a 5K, instead walk it and choose activities that aren’t super-high-impact in nature. 

So what’s my point? Be happy in who you are. Accepting yourself, your body, your looks for what they are is a good thing. But please don’t confuse self-acceptance with denial of the clear and real risks that obesity brings with it. You’ll not be doing your self – or your self-esteem – any favors.