Sunday, October 05, 2008

Fat Acceptance

I don't know too many women who are happy with their weight. It's a topic that comes up often in psychotherapy, and the degree of someone's distress seems to have little to do with the patient's actual weight: slim, fit women are often obsessed with wanting to be a few pounds lighter, and while heavier women also wish to be thinner, their distress isn't proportionally more-- so someone who is 50 pounds heavier than they'd like to be is not necessarily 10 times more distressed than someone who is 5 pounds heavier than they'd like to be. And outside of therapy, in the course of conversation with friends, oh, it seems if you stick people in a room for long enough, the subject of weight and diet becomes inevitable.

It seems we've all signed on to the idea that thinner is better and thinner is healthier. We take this as a given and somehow it's something we've bought into so strongly that we don't even question it. It's unhealthy and that's the refrain, but we also think fat people are fat because of laziness, lack of self-control, bad habits, and "how did she let herself get so fat?" In essence, it becomes okay to blame people for being heavier than we think they should be, and often they agree.

Okay so...and you knew I was going today's Sunday New York Times Magazine, Robin Marantz Henig writes in "Losing the Weight Stigma" :

Scientists who study obesity at the cellular level say genetics determines people’s natural weight range, right down to the type and amount of food they crave, how much they move and where they accumulate fat. Asking how someone got to be so fat is as meaningless as asking how he got to be so tall. “The severely obese have some underlying genetic or metabolic difference we’re not smart enough to identify yet,” says Dr. Rudolph Leibel of Columbia University Medical Center. “It’s the same way that a 7-foot-tall basketball player is genetically different from me, at 5-foot-8.”

Fat has been blamed for cardiac trouble, diabetes and some forms of cancer. But fat-acceptance activists argue that the epidemiological studies that link fatness to disease often fail to adjust for non-weight-related risk factors found more often in fat populations. Poverty, minority-group status, too much fast food, a sedentary lifestyle, lack of access to health insurance or to nonjudgmental medical care, the stress of self-loathing and being part of a stigmatized group — all are more common among fat people, and all are linked to poorer health outcomes at any weight. This makes it harder to say to what extent an association between obesity and disease is due to the fatness itself or to the risk factors that tend to go along with being fat.

It remains an open question, one deserving of further scientific scrutiny, whether the health risks seen in fat populations are caused by the fat itself or by something else. Only then can we really know how to effectively wage the war on obesity — or if such a war even needs to be waged.

Henig makes the point that there are many slim people with cardiac disease, diabetes, and cancer (illnesses associated with being overweight) and that half of overweight people-- and a third of obese individuals--- have normal blood pressure, cholesterol, and blood sugars.

The issue of "health" gives credence to the belief that it's best to be slim-- but regardless of the health issues, as long as thinness is equated with attractiveness, we might all still want to be a little thinner.