One evening I was hanging out with my flatmate in my pyjamas. I was eating my pasta and doing some work on my laptop while chatting to him about his latest boyfriend. I was feeling quite content. Then we got company – my flatmate’s friend came over. I haven’t met this guy many times, so we awkwardly said hello to each other. As he was taking off his coat and scarf, he immediately blurted out, ‘So, there is something I’ve wanted to hear your opinion on for a while.’
Usually, when presented – by a man – in such a confident and urgent tone, this only means one thing: There is something I’ve wanted you to hear me say for a while.
Then he started talking and didn’t stop for half an hour. He had once been fat and people in his family were still fat, so he knew everything about being fat, he explained. He told me that it was unhealthy being fat and that, if you are fat, you will die. Soon. Finally he was quiet, eagerly awaiting my response.
I was still just eating my pasta, living my fat life. I blinked a few times, not quite knowing what to say. It’s quite a lot to have thrown at you, on a regular Sunday evening when you’re in your pyjamas. That I’m going to die real soon because I’m so fat. I had really been looking forward to this pasta.
He continued, ‘So I just think there should be a limit to this body positivity.’
Which doesn’t sound a lot like a question. It sounds more like a frustration that he had kept inside for a while, that he needed me to agree with. He was eager to make me admit that if we all just love our bodies then everyone will get fat and die. I didn’t agree with him, but I wasn’t able to tell him that because each time I started a sentence he would interrupt me. I would say, ‘Studies show—’ and he would shout, ‘What studies? I’ve not read them!’ and I would say, ‘Well, there is one from 2014—’ and he would say, ‘I’ve never heard of these studies!’
This went on for so long that, by the end, I stopped trying to speak at all. I texted a friend under the table to call me and pretend I had to be somewhere, which she did because women are awesome. I excused myself and as I got dressed, he told me that he enjoyed talking to me about this and that he couldn’t wait to read my book. I’m really glad he said that, because the greatest thing about writing a book is that no one can interrupt you when you are writing it.
There are two types of ways people usually ask me but what about health?
The loudest way comes from the trolls on the internet, from the fatphobes, from people like my flatmate’s friend who are just looking for an excuse to diminish the idea of fat people gaining liberation. The question but what about health? is usually loaded with animosity, and it usually doesn’t make much sense within the context of the conversation. A fat activist will ask to be treated with respect and the troll on the internet will say, but what about health? as if being unhealthy somehow removes your right to be treated well.
Then there is the quieter type, the type of but what about health? that comes from a place of genuine concern, fear and confusion. Often from fat people who have been told that just because they are fat, they are in mortal danger of dying immediately from various diseases, or who have been hit with the less empathetic but what about health? whenever they have expressed a desire to feel content in their bodies.
I want to address both and I want to start with the loudest, because it’s impossible to not feel affected by their loudness, their anger and their indignation over Fat Liberation and body positivity. So, to the man on my couch, shouting at us all as we are wearing pyjamas and eating pasta, let’s just take it one bit at a time.
Q: So, is it unhealthy being fat?
A: Physically? Not necessarily.
The establishment clings to the belief that weight causes disease and death just as people once insisted that the world was flat.1
Dr Susan Wooley, Professor Emerita, University of Cincinnati, 1998
In 1993, something very interesting happened. Two scientists called McGinnis and Foege published an article called ‘Actual Causes of Death in the United States’ that declared ‘diet and activity patterns’ as one of the main reasons why Americans died, alongside things like firearms, smoking and a lot of other causes.2 Basically, exercising and eating what is considered a healthy diet is healthy. However, their data began to appear in the media and in research articles being attributed not to diet and activity patterns, but to fat. You’ve seen the headlines before.
THE OBESITY EPIDEMIC
OBESITY KILLS
IF YOU ARE OBESE, YOU WILL ABSOLUTELY DEFINITELY DIE IMMEDIATELY
McGinnis and Foege protested as much as they could. In the New England Journal of Medicine, their letter to the editor was published, in which they said:
You and Dr. Angell cited our 1993 paper as claiming ‘that every year 300,000 deaths in the United States are caused by obesity’. That is not what we claimed. Instead, the figure you cite applies broadly to the combined effects of various ‘dietary factors and activity patterns that are too sedentary’, not to the narrower effect of obesity alone. Indeed, given the contribution of multiple diet-related factors to problems such as high blood pressure, heart disease, and cancer, we noted explicitly the difficulty of sorting out the independent contribution of any one factor.
Two things are happening there. McGinnis and Foege are being absolutely badass legends, doing a mic drop in a medical journal. And also, they refer to high blood pressure, heart disease and cancer as diet-related factors and not – like most articles do today – obesity related. They also point out that it is very difficult to pinpoint just one independent factor.
So, to conclude: scientists did a study about the causes of death and never once mentioned fatness, and suddenly every media outlet blamed fatness anyways. This is one example – albeit a pretty huge one – that shows why we all seem to so stubbornly believe that fatness is the direct cause of all illnesses and death ever. I have seen many instances of this.
Despite health being such a super-complex multifaceted concept, covering mental health (which includes anything from stress, depression, anxiety and general feelings of low or high self-worth), metabolic health and lifestyle elements (such as food, alcohol, drugs, tobacco, if you exercise and how, how much you sleep, if you participate in extreme sports, violent sports or if you regularly walk into traffic without looking), it is often assumed that you can tell, just by looking at a person, whether or not they are healthy. Fat and unhealthy are almost used interchangeably and the connection is very rarely questioned.
Is it unhealthy being fat? is a ridiculously simplistic question, because when is a person ever just one thing? When is health ever just one thing? Which I think is part of the reason why ‘fat is unhealthy’ is being thrown at people so often: because it is simplistic, being fat sounds dangerous, and it takes a lot of explaining to debunk. I tried to get this whole chapter into a tweet but it quite quickly exceeded the 280 character limit.
It’s hard to argue against something the whole world seems to think is true. I mean, for example, let’s look at the term fat-thin. Remember when that started being a thing? Front covers of magazines warning us: EVEN THOUGH YOU ARE THIN, YOU MIGHT STILL BE FAT!
Fat-thin is actually called ‘Metabolically Obese, but Normal Weight’ (MONW). It is when thin people are at a higher risk for type 2 diabetes and cardiovascular diseases.3 Illnesses that we are used to attributing to fat people. There are also fat people who are ‘Metabolically Healthy, but Obese’ (MHO). Meaning they are fat but otherwise completely healthy. No heart disease, no diabetes, none of that. Actually, some studies show that up to 35 per cent of fat people might actually be metabolically healthy.4 That’s over a third of all fat people.
Metabolically healthy just means no high blood pressure, cholesterol or raised blood sugar. It only covers a small part of health – but it’s the one that most people often think about when you discuss fatness and health. High blood pressure, cholesterol or raised blood sugar.
An article written in the European Journal of Clinical Nutrition in 2010 by scientists from the Department of Nutrition and Dietetics at the Portuguese Institute of Oncology,fn1 concluded, ‘Physical activity increases the likelihood of presenting with MHO, and MHO is associated with a lower prevalence of family history of type 2 diabetes.’5 Which states that you can be a healthy fat person, if you are physically active. And the article concludes you are more likely to get type 2 diabetes if it runs in your family – not if you are fat.
In the research journal Obesity, a 2016 paper on a study that looked at data for nearly 20,000 people spanning nineteen years, found that the ‘Metabolically Obese, but Normal Weight’ were about twice as likely as the ‘metabolically healthy fat’ to develop diabetes.6 And in the journal Progress in Cardiovascular Diseases in 2014, they stated that fit fat people had the same mortality risk as fit thin people. The authors urged researchers, clinicians and public health officials to ‘focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk’.7 And if we turn our heads to the copy of the 2012 January–February edition of Journal of the American Board of Family Medicine that we all have on our coffee tables, we can read Matheson, King and Everett’s study which shows that healthy lifestyle habits are associated with a significant decrease in mortality (people die less) regardless of BMI.8
So just to summarise: there are thin people who get type 2 diabetes and cardiovascular disease and there are fat people that don’t. Across the board, it looks as if physical activity and a healthy diet is actually what affects your (metabolic) health. Yet, instead of admitting that it’s not unhealthy just being fat, but that it’s a matter of your lifestyle, we get weird, self-contradictory terms like fat-thin. These studies are also referred to as The Obesity Paradox.9 It goes to show just how adamantly we want fatness to be an indicator of ill health. Even in medical science, if someone has a high risk for cardiovascular disease or diabetes, they are sometimes just classified as ‘obese’, instead of attributing the propensity to the diseases to something other than size. And when an abundance of scientific research shows that, actually, fatness doesn’t make you sick, that a bad diet and not moving your body enough can make you sick, then it’s a strange paradox. Instead of just science. Proving the common discourse wrong.
The language around fatness in medical science is a huge part of why we all seem to think that it’s just, simply, unhealthy being fat. We have all been spoon-fed this idea since we were born. It makes sense. It scares us. It’s scary. It’s scary to be told that your body is going to kill you at some point with its fatness. And that fear sends us straight to the gym, straight to Slimming World, straight to our doctors to ask for weight-loss surgery. We’re ready to do anything to avoid this Death By Fatness, including giving all of our money to corporations. To corporations who happen to sponsor a lot of medical studies.
In 1999, obesity researcher Dr David Allison published a study that claimed that approximately 300,000 people died every year from obesity.10 In 2004, the Journal of the American Medical Association, the same journal that published David Allison, published a new study by the Centers for Disease Control and Prevention which upped that number to 400,000 people. And then it starts to unravel.
In just over a year, Allison’s study is picked apart. An American congressman called Henry Waxman requests a Government Accountability Office investigation. The American Journal of Public Health and the Wall Street Journal criticise the methods used to reach the study’s deductions. Researchers Katherine Flegal and David Williamson from the Centers for Disease Control and Prevention start to debunk the study. Finally, in April 2005, alongside researchers from National Institutes of Health, they publish a study in the Journal of the American Medical Association, attributing less than 26,000 deaths to ‘obesity and [being] overweight’. That’s fifteen times lower than the original estimate,11 and when questioned on it Dr Allison stated, ‘These are just back-of-the-envelope, plausible scenarios … We never meant for them to be portrayed as precise.’12
David Allison has reportedly received funding from basically every big player in the weight-loss industry, including Weight Watchers, SlimFast and a whole lot of diet pill companies. An article in Scientific American from 2006 reports that he ‘discloses payments from 148 such companies’ – all companies that profit from people being terrified of dying from fatness.13, 14
It’s worth thinking about. That there are people and companies financially benefiting from the idea that there is an ‘obesity epidemic’ which is going to kill us all.
And that the truth is, actually, it’s not that bad. The truth is it’s not as simple as equating ‘fat’ with ‘unhealthy’. That you can’t just look at another human being and determine if they are sick or not.
I am not saying that it is without risk being fat. I am saying that perhaps the risk isn’t what we think it is. We are used to believing that fatness is unhealthy because of the actual cells of fat that exist on our body – instead of looking at the effects of the outside world on our bodies.
Q: So, is it unhealthy being fat? A: Oh, you mean because people treat fat people like shit? Then yes, definitely.
Fat people going to the doctor
I had a bit of a scare recently when I went to the doctor’s. I was there to ask for a prescription for a contraceptive pill as I had recently – and quite mistakenly, as it would later turn out – entered into a committed relationship with a sperm-producing man. It was the first time I had seen this particular doctor. Before I even had a chance to tell her why I was there, she asked me my weight, so she could check my BMI.
‘BMI? Wasn’t that debunked decades ago?’fn2 I asked, more perplexed than upset. She didn’t react, she just sighed and awaited my response. The very mention of weight and BMI came as a shock. I had not prepared myself to discuss my fatness.
I said, ‘Well. I don’t know what I weigh. I have not weighed myself for six years. I have an eating disorder – and it’s under control now, but I don’t want to trigger it, which talking about weight will do.’
She got up and walked over to the scales. ‘You will have to be weighed.’
I said, ‘Why? It will without a doubt say that I am “morbidly obese”. It won’t say I am skinny. We can both see that I am fat.’
She remained silent next to the scales as if she was a parent waiting for her difficult child to stop acting up. I got up and walked over, not quite believing what was happening. I stepped up on the scales and as I was about to ask her to at least not tell me the result, she did. Oh. I stepped back down and we walked back to her desk. She typed the numbers into the calculator and said, ‘Ah. You are morbidly obese. You’ll need to lose weight.’
At this point, I had tears in my eyes. Not because of the wild revelation that I am fat. Nor was it because I believed that I needed to lose weight. I know that if I even begin to consider attempting to lose weight, my mind will spiral within minutes and less than a week will pass before I have two fingers down my throat after having sucked on a frozen grape for an hour. And I know that diets don’t work. I had tears in my eyes because I never asked for her opinion about my weight. I did not come to her with any symptoms or illnesses. I was, for the first time in my life, psychologically healthy. I was beginning to see my way out of a stressful life in which I never knew if I could pay my rent or not. I no longer surrounded myself with people who were toxic and who made me feel bad about myself. I slept well each night, I didn’t have any obsessive thoughts about food. I had begun to love myself and my body. I had started performing, which filled me with joy. I even moved my body way more than I ever had before – not to lose weight, just because I was busy with life. And now I also had this boyfriend who was kind and respectful. I had finally reached a point in my life where weight didn’t hold me back. It didn’t make me miserable. I was happy. I felt healthy. But now, due to her comments, I was spiralling.
I shouldn’t have been surprised that she disregarded my protests. I had read and heard about medical bias – the statistics had been bouncing around my brain for hours before my appointment. In a study from 2012 made by the North American Association for the Study of Obesity, two out of three doctors say overweight patients ‘lack self-control’, and 39 per cent said obese people are just lazy. Forty-nine per cent of nurses say they’re uncomfortable working with fat patients, and 31 per cent of nurses indicated openly that they would rather not have to care for fat patients. Twenty-four per cent of nurses said working with fat patients repulsed them.15
There is even the mindblowing survey that had a control group of a couple of hundred people, and was carried out over a time period of fifteen years, which showed that the fatter a patient is, the more likely a surgeon is to leave sponges or even surgical instruments behind, which necessitates further surgery for 69 per cent of such cases.16
I had heard all the horror stories about fat people going to the doctor with a broken finger only to be sent home with a Slimming World introduction pamphlet. In online circles, where fat people feel safe amongst fellow fatties, stories like this are being shared all the time.
Not to say that medical professionals are necessarily more biased or fat-hating than other professions – although it would make sense as a lot of science regarding fatness is inherently fatphobic, since there is a lot of money for research if you are intent on proving that fat is dangerous, all sponsored by, guess what, the weight-loss industry. So if you are a doctor, you are pretty much surrounded by studies that say that if thin people have diabetes, it’s because they’re actually fat. But also, fat bias is inherent in all cultures, so it affects everyone. I am sure that the same numbers go for bus drivers, waiters, teachers and lawyers. Of course doctors will be biased towards fat people – a bitter assumption to make, but there is no reason why our cultural bias would have passed doctors by. I am not saying that all medical professionals are evil or out to kill all fat people. In fact, I have had two very positive experiences with doctors – where my weight was rightly never brought up because it was not relevant to the reasons I was there. But I still arrived anxious – because it is part of being a fat person in a doctor’s office. Oh no. What are they going to say now?
It’s one thing hearing about the statistics and the stories, but it’s another thing altogether having them happen to you.
‘I can’t attempt to lose weight,’ I just stuttered through the tears. She immediately started talking – turns out, all I needed to do was exercise a bit and then eat fewer calories than I burn. I wanted to start explaining to her that all she had to do to be a doctor was to wear a white gown and say scalpel a few times, in the hope that she would see how surreal it was for her to tell me – a fat person – about losing weight, as if that option had never occurred to me before. As if I am not very much the number one expert in the field of My Own Attempted Weight Loss.
‘No, I can’t – if I start counting calories or exercising to lose weight, my, uh, eating disorder will come back and … I will be very sick,’ I mumbled.
She then suggested that I could just wake up thirty minutes earlier than usual and go for a walk. I whispered the words ‘eating disorder’ again but she didn’t react.
She brought out the blood-pressure machine. She wrapped the bond around my arm and tightened it. As the monitor started working, she looked concerned, like the scrunchie in her hair was too tight. She released the band and wrapped it around my arm again. Then looked at the monitor again. She left the room for a decent amount of time. Then returned. As usual, when a doctor looks scared, I start to accept death. Oh, I have cholera. It’s definitely cholera. Or rabies. Or I have no blood. I have been drained of blood. I want white roses at my funeral.
The doctor came back, sighed and sat down.
‘Your blood pressure is—’ she began and I finished her sentence in my mind. Non-existent because there is no more blood.
‘Normal.’
Once you get a diagnosis, your world stops for a second before you realise you now have to live the rest of your life in a different way. When I was diagnosed with ‘normal blood pressure’, I knew that, from then on, I would have to start taking precautions, such as, for example, keep doing whatever I was doing, because apparently, it had all been fine.
My doctor put away the monitor, which she had thought was broken. She then refused to give me the contraceptive pill.
‘It is dangerous, if you have high blood pressure.’
‘But. You just said I had normal blood pressure.’
‘Still.’
I left without my prescription.
On my way home, I bought a bag of apples. I don’t particularly like the taste of apples; they are too sour, too hard to bite into; nothing about them is appealing to me. Apples are what I buy when I am headed face first into disordered eating patterns. I turn to food I dislike, because food immediately becomes about punishment – instead of about joy and nutrition. I sat at home, staring at the apples, feeling like running. Running so fast and so far that every muscle in my body felt like it was on fire, till I couldn’t breathe and till I would collapse. Because movement no longer felt playful, it was a necessity to get thin. Get thin quick.
My relapse lasted a few days, before I finally managed to work through it in therapy. Ironically, I decided that to look after my mental health I might need to stay away from my doctor, because she seemed to make it all a lot worse. Finding a new doctor seemed like a big task. It was hard to imagine that the next one would be more understanding or less fatphobic.
In 2015, sixty-year-old Kevin Daly from Hoboken, New Jersey went to the doctor, complaining that his stomach felt too big. The doctor told him to lose weight. After having lost 35lb, Kevin Daly’s stomach still had not shrunk one bit. After he had demanded a scan, it came to everyone’s attention that he had a 30lb tumour in his stomach. That is, in medical terms, a fucking huge tumour.17 In 2017, 57-year-old Roger Logan had a 130lb tumour removed after having been told by doctors for years that he was ‘just’ fat and should lose some weight.18 Trevor Smithson, fifty-three, from Yateley, Hampshire, was told to lose weight by experts at the Royal Berkshire Hospital in Reading and they failed to notice the 55lb tumour in his stomach despite carrying out three operations on him.19 I have yet to meet a fat person who is surprised by this – and I am yet to meet a fat person who is not afraid of going to the doctor for this same reason. Studies show that fat women are less likely to seek medical help than non-fat women.20 They are worried that the ‘diagnosis’ will just be ‘fat’ and the cure just ‘to lose weight’, regardless of why you are there.
Ellen Maud Bennett did not know she had a tumour until three days before she died in 2018. Her obituary in the Victoria Times Colonist went viral as she had decided to make a very special point:
A final message Ellen wanted to share was about the fat shaming she endured from the medical profession. Over the past few years of feeling unwell she sought out medical intervention and no one offered any support or suggestions beyond weight loss. Ellen’s dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue.21
We want to trust doctors and we want to feel safe in the knowledge that we can always get the medical help we deserve and need. Fortunately, we can discuss our experiences online and, at the very least, get support from our community. Because it’s important that we know that we are not alone in being discriminated against in the doctor’s office. And that we are not wrong when our gut feeling tells us that something isn’t right.
Linda, who is behind the blog Fluffy Kitten Party, often discusses her experiences as a fat person with an illness. In one post,22 she describes how she went to the doctor because she kept waking up with really painful acid reflux. When the doctor was to take her blood pressure, he simply refused to touch her. Instead, he put in a number he made up into the system which then ended up informing them that her blood pressure was way too high. She later demanded that someone did take her blood pressure – and when they did, it turned out to be just fine. The medical professional simply did not want to touch her.
A survey in 1998 by researchers Fontaine, Faith, Allison and Cheskin at Johns Hopkins University School of Medicine looked at 6,000 women, and when age, race, income, education, smoking and health insurance status were adjusted for, it showed that fat women (defined by having a BMI over 35) were more likely than non-fat women (defined as having a BMI of 25) to delay clinical breast exams, gynaecological exams, and pap smears, which the researchers said could exacerbate or even account for some of the health risks associated with fatness. In the foreword of The Fat Studies Reader (which is amazing and absolutely necessary if you want to get into fat activism) written by Marilyn Wann (who is amazing), she notes that mammograms, which do not require physician/patient contact, were unaffected by BMI. She writes this ‘may indicate obstetric/gynaecology physicians’ hesitation to touch fat patients’.
The Fat Liberation Movement isn’t centred around health at all. It’s all about ending discrimination and achieving equal rights. I know many fat activists, such as the fatlicious Cat Pausé, who have simply started to refuse to answer questions about health. Because it’s not the point of the movement. It derails from the actual and urgent need for equal rights. We should not have to be deemed ‘healthy’ to be treated with respect.
It’s overwhelmingly dangerous for your mental health to be reduced to your weight, which is subsequently treated like an illness that needs to be cured, when whatever you actually went to the doctor’s to address has been overlooked.
Fat people are discriminated against in pretty much every thinkable situation. All public spaces are potential threats, all popular culture either confirms our worst thoughts about ourselves or erases us completely. Other people will most likely either hate us or ignore us, doctors will refuse to look past our stomachs in order to cure us, dating is a whirlpool of rejections and humiliation and we will get paid less,23 hired less24 and can be legally fired for being fat.25 There just does not seem to be room or want for us in the world.
To say that being fat is stressful is an understatement. In 2010, Professor Michael Inzlicht from University of Toronto wanted to find out the long-lasting effects of having experienced prejudice. Inzlicht and his team found out that even in the time after having been stereotyped, people were less able to control their aggression, or make rational decisions, and they would overeat.26
In writing this book, whenever I have described a fatphobic incident, I have physically felt the effects in my body. I have had to take a step back, consult with my therapist and work through the frustration, the sadness and the, in lack of a less overused word, trauma. I could feel it, in my stomach. Even remembering some of these events made my heart beat faster and made me want to go back to bed.
In a study published in the American Journal of Public Health, they asked Latin Americans to deliver a speech to a racist person. The people’s reactions were tested before and after and there was overwhelming evidence that even just the anticipation of prejudice leads to both psychological and cardiovascular stress responses.27 Other studies have shown that discrimination can lead to depression,28, 29 common colds,30 hypertension,31 coronary artery calcification,32 breast cancer33 and death.34
These all sound painfully similar to the diseases usually attributed to fatness. We need to consider if the supposed correlation between fatness and cardiovascular diseases, diabetes, cancer and death is actually to do with the cells of fat (for which there is not a lot of direct science) or could just as well be due to lack of access to proper health care or the discrimination fat people face on a daily basis.
Peter Muennig, assistant professor at the Mailman School of Public Health at Columbia, published an article in 2008 in BioMed Central, a peer-reviewed portfolio of scientific-research journals. His article contemplated the idea that any correlation between fatness and health might not be to do with weight.
In his conclusion he states, ‘Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms.’
To come to this conclusion, he examined the relationship between what people think about their bodies and their health. Peter Muennig makes it clear in an article, published in the American Journal of Public Health,35 that he has used 2003 Behavioral Risk Factor Surveillance Systemfn3 data to figure out the impact of the way you see yourself on your general health. This study showed that the more people wished to lose weight, the more unhealthy days they had a month. For example, people who wished to lose 1 per cent (basically, people who don’t want to lose any weight) had on average 0.1 physically unhealthy days per month,36 whereas people who wished to lose half of their body weight suffered approximately six physically unhealthy days per month. Bear in mind that this is all about what they wanted to lose and regardless of actual weight.
A clinical study in the Journal of Obesity, published in 2013, showed that people who were dissatisfied with their weight had poorer health than their similar weight counterparts. Fifty-five point three per cent of dissatisfied women experienced yo-yo-dieting compared to 25 per cent of satisfied women. Dissatisfied people had the highest rates of hypertension, diabetes, and hypercholesterolemia.37 And a study published in the Health Psychology Journal in 2014 showed that chronic weight dissatisfaction, regardless of BMI, increased the risk for type 2 diabetes.38
Basically, the shame (and discrimination) makes us physically and psychologically worse. This isn’t hard to imagine. Stress and low self-esteem can make you not want to take care of yourself, because what is even the point? Why get that mole checked out, why drink water, why even try to go out and hang out with friends, when the message you receive on an hourly basis from the whole world is: You shouldn’t exist. You have no worth. When your inner voice is just one, long, loud scream, there is no room to feel.
Feel what you really want, feel how you really feel, feel what you really need. The healthiest thing you can do is reach a point where you are happy with your weight and your body. And the healthiest thing we can do to fat people is stop shaming them. Trying to shame people into being healthy is like trying to get someone to smell less of piss by pissing on them.
A study from 2004 about shame39 found that feelings of ‘low social standing’ increased people’s cortisol levels and their sensations of low self-worth. A 2002 research report funded by the US Government came to the same conclusion.40 Cortisol is fairly important – it’s a stress hormone that manages how you use your fat, it regulates blood pressure, increases blood sugar and controls your sleep cycle. If you have high levels of cortisol, you are stressed. Your body gets the signal that it’s in danger. And stress can lead to heart disease, anxiety, depression, diabetes and weight gain.
So to summarise again, just so that we’re all on the same page: wanting to lose weight seems to be a higher predictor of ill health than BMI or, just in general, how fat you are. Whereas it is clear that experiencing shame and discrimination can lead to diseases that are usually associated with fatness.
Seeing fatness as a disease to be cured dehumanises the many, many fat people in the world. We become those headless fatties on the news with the word EPIDEMIC underneath. When fatness becomes synonymous with illness, it erases all potential for other dimensions of fatness to thrive.
Simplifying health and fatness is impossible. Both are complex, ever-changing and multifaceted: they don’t exist on their own or outside of an elaborate context. All of this complexity is lost as soon as we accept as a fact that fat is inherently unhealthy, thin is inherently healthy. When actually, this couldn’t be further from the truth.
What do we really want? Do we actually want for fat people to be healthy or do we want them to be ashamed?
Just a reminder to maybe give your stomach a cuddle. We have talked a lot about disease and discrimination. Let’s just, for a moment, remind ourselves that we’re okay and we will be okay. That our worth is not based on our health.
The question ‘But what about health?’ usually comes with negativity attached. From people who are angry at fat people on the news, from trolls on the internet, from people sitting on my couch. There is rarely much ‘caring’ in their intention when they ask the question. Usually, when they tell you to lose weight, they just want fatness to disappear. Fatness is scary, wrong, excessive and contagious. ‘Lose weight’ is presented as a rule, almost desperately, because, if only you were thin, it would be easier to relax around you. When you are told to ‘lose weight’, it is almost said with a hint of ‘how dare you?’ How dare you be fat, when we have accepted that it is wrong? How dare you be fat, when I am not allowing myself to be fat? Or, how dare you be fat when I am fat too and I hate it?
The lack of genuine concern here is obvious: people don’t interrogate thin people about their health in the same way. People don’t ask ‘but what about your health?’ under the photos of people going bungee jumping. There is not a moral outrage when a thin person posts a photo of them eating a burger or drinking a beer. There is actually a whole trend on YouTube of small, beautiful, cis women eating large amounts of food. It’s celebrated. When fat people eat food, it’s demonised. ‘You shouldn’t be eating – think of your health.’ These people are not concerned about our wellbeing. They don’t want us to be happy. They want us to not exist.
Also, have you seen men’s football? It is very entertaining. But it is also a bunch of tall, muscular men running with full speed and throttle into each other, causing other tall, muscly men to roll around on the grass, screaming in pain. We are talking ankles being twisted, shoulders dislocated, teeth being knocked out by an elbow, hamstrings snapping. However, I am yet to see anyone be furious about the health risk that these men put themselves through. I can’t wait till a fat footballer arrives, so that a whole lot of people on the internet can tell him to get healthy and lose the weight so he can properly get kicked in the face by another grown man in the name of sports and entertainment.
People who care listen. And if they will only listen, they will understand that shaming and discriminating against fat people is as damaging as they claim being fat is. If people actually listened, they would notice that Fat Liberation is about fat people’s right to live without being discriminated against. In the Fat Liberation Manifesto, published in 1973, which I’ve placed in the back of this book, two of the seven points are: ‘WE believe that fat people are fully entitled to human respect and recognition’, and ‘WE demand equal rights for fat people in all aspects of life … We demand equal access to goods and services in the public domain, and an end to discrimination against us in the areas of employment, education, public facilities and health services.’ These are our basic rights. Even if we were all unhealthy, that would be beside the point.
(The other way we know that they definitely don’t care about us is that the first Fat Liberation Movement took place in the 1960s. That’s decades ago. I’m not making any new points that other people haven’t already made. If these people truly cared, they would have separated fatness and health back when the first studies proved them wrong. But it is more lucrative to categorise an entire population group as ‘forever and fatally diseased’ than it is to dismantle the patriarchal and capitalist system that actually kills them. We call it concern trolling. When someone disguises their contempt with the illusion of wanting to help.)
We need to stop glorifying health. It is a privilege to be healthy. Not everyone has the time and the money that it takes to ‘get into shape’ and ‘start eating healthy’. Nor does everyone have a brain that’s willing to give them the emotional energy that is required to start cooking your own vegetable-y meals, or to even leave their house. There are people with eating disorders for whom any kind of food restriction can be triggering. And there are enough instances of people taking photos of fat people in gyms in order to mock them online to demonstrate why there are fat people who would never come within an inch of a gym. Not to mention that there are bodies that are just chronically ill. Bodies that are just sick.
When we glorify health, we demonise and marginalise disease and disability. We cannot allow for the healthy to be seen as superior to those who are not healthy. We are all worthy of respect, regardless of what we eat or how much we exercise or whether or not we bother to make a smoothie in the morning.
Not only is it wildly complicated and individual, but my health is also no one’s business but mine. Seriously. Chances are that there will be people in your life who have asked you to take better care of yourself. And maybe your family members or friends mean well. But no one is entitled to judge you on how you live your life, and no one can tell you what to do. You have full autonomy over your body. You do not owe it to anyone to be healthy.
Choosing to eat ice cream over a carrot affects no one but yourself. We are so tempted to apologise for ourselves all the time. I have certainly done so myself, and perhaps I have even done it subconsciously in this book. I don’t exercise because it triggers an unhealthy psychological circle of shame to do with my body, I don’t eat well because it triggers my eating disorder, I got fat because I was depressed and a victim of bullying. And while all of that stems from the truth, I shouldn’t have to make these excuses. It’s no one’s business but mine why I eat what I eat or why I don’t do the yoga that I don’t do. Health is, first and foremost, personal. You don’t owe it to your partner, your family, your doctor or to strangers to live a healthy life. If you choose to be healthy – and if you have the resources and abilities to do so – that is one hundred per cent your own decision.
Imagine if we weren’t shamed into losing weight. Imagine if weight loss was just simply never mentioned. If instead, nutritional and healthy food was made more accessible and affordable.41 If gyms no longer had fat-shaming messages on the walls and there were no calorie-counters on the machines. If you were encouraged to exercise because moving your body can be fun. Imagine if the messages you got about your body were all positive. If there was no shame attached to fatness. Imagine if there were no discernible economic inequality in the UK42 and therapy was free and accessible to everyone. Imagine if there were no ‘good foods’ and ‘bad foods’. Imagine if it was illegal to financially benefit from people feeling miserable about themselves. It makes me feel wholesome and happy just imagining this and yet I understand why they hired John Lennon instead of me to write that song.