Between Shame and Acceptance

There has been a lot of talk in the popular press recently of “Fat Shaming” and “Fat Acceptance”.

Two such high-profile instances that caught my eye were:

An Open Letter to Jamie Oliver by Laura Thomas

and

Everything You Know About Obesity Is Wrong by Michael Hobbes

As ever, the media reaction has been polarised, with most responses I’ve seen being either whole-hearted acceptance, or vitriolic derision.

I hope here, as always, to try to offer a more nuanced view.

A War on Reality

I’m going to start with the “Open Letter to Jamie Oliver”.

I want to take a skeptical look at it, though the cynical side of me can’t help but think that the real motivation behind this is (an effective) publicity stunt, but I digress…

“By talking about “war” and saying “the future of the NHS is at stake”, we worry that you are contributing to a stigmatising and divisive conversation about weight.”

Really?

It’s been estimated that Obesity costs the NHS at least £5.1 billion each year (figures from 2005/6 which if anything have since increased).

The NHS is already struggling, how is claiming that obesity is putting immense strain on the NHS anything else but objective fact?

With regards to “war”, obesity is a medical condition. Cancer is another medical condition. Oliver clearly meant we should fight a war against obesity, akin to the “War on Cancer” campaign from the US in the 1970s.

No one took offense to the idea of a war against cancer, or thought that such a name could result in a “stigmatising and divisive conversation about cancer” – why should obesity be any different?

“Children are particularly vulnerable to the consequences of weight stigma (bias or discrimination related to size), with higher weight children being 63% more likely to experience bullying”

Children can be little %^&*. I’ll come back around to this later, but obviously I am not a proponent of shaming or bullying someone because of their weight.

The answer to this problem, however, is not to pretend that obesity is not an issue, or attempt to normalise it.

“We know that children who experience weight based bullying or teasing are more likely to diet or to try to control their weight in other ways”

Quite bizarre to even include this statistic in the letter, as taken in isolation it sounds like a pretty good argument in favour of fat shaming!

Indeed, what exactly is wrong with a child attempting to reduce their body fat to a healthier level?

This is only a problem when the child does so in an unhealthy manner – starvation, overly restrictive diets, dubious supplements etc, none of which are strategies that Jamie’s campaign is pushing for.

“We are so afraid of “obesity” that parents are engaging in weight-related talk with children as young as two-years old…it’s estimated that 40% of parents have encouraged their children to diet. This is counter-productive given that body dissatisfaction and dieting are not only predictors of disordered eating, but of long-term weight gain.”

Not quite sure why obesity gets the “–” treatment here, nor why parents shouldn’t be concerned about their children falling victim to it. It’s one of the most prevalent medical conditions in the developed world, that severely compromises both quality and length of life.

Parents need to be educating their children on healthy eating, teaching them to cook, and encouraging them to live healthy lifestyles. In order for them to do this, the parents themselves need educating. That’s not going to be easy. I refer you back to the war analogy…

“Although unintended, campaigns and policies that focus on body size and weight, rather than health & well-being more broadly, contribute to weight stigma. Weight stigma has increased by at least 66% since the 1990s – far more than can be accounted for by the increase in body weight over the same timeframe.”

All very spurious. The study linked to with regards to the “66% increase” since the 90s is weak to say the least.

Could raising awareness that obesity puts added strain on an already struggling health system generate animosity, thus leading to increased stigma? I’ll grant that this is possible, but it doesn’t stop it being an objective fact. You can’t simply ignore or try to hide the truth for fear of hurting people’s feelings.

“Furthermore, the scientific evidence is clear that people can be metabolically unhealthy at a lower weight, and metabolically fit at a higher weight”

Yes, this is possible – indeed, I’ve written before about how glad I am that I gain fat relatively easily as it provided motivation to eat well and exercise.

The vast majority of overweight people however, are considerably  less healthy than the vast majority of normal weight people.  Even if this weren’t the case, the minority of overweight people who are relatively fit and healthy would still see additional benefits to their health, longevity and quality of life, were they to lose some or all of their excess body fat.

Of course, there are slim people out there who would also benefit greatly from improving their diet and lifestyle. No one is denying this.

The recent 5 Big Healthy Lifestyle Factors report identified “Maintain A Healthy Bodyweight” as 1 of the 5 factors. That leaves another 4 that all slim people also have to worry about.

Again, I firmly believe that those relatively rare individuals that can stay slim while living a sedentary lifestyle and overeating are actually the unlucky ones!

She then goes on a big waffle, before concluding:

“>Focus on health improvement rather than weight management – frame your message in a weight inclusive manner that promotes wellbeing for all”

But how exactly? How do people know if they are eating well and getting enough activity?

I did take issue with the inclusion of “Maintain a Healthy Body Weight” in the Big 5 Lifestyle Factors, as this is not an actionable behaviour.

Excess body fat, however, is a visible, measurable and quantifiable sign that someone has an energy imbalance – that they are consuming more calories than they are burning – the root cause of metabolic disease and likely driver of diabetes, heart disease and many forms of cancer.

Promote body acceptance and diversity which will lead to people feeling better about themselves and may make it more likely that they will engage in health promoting behaviour whilst also supporting their mental health

I’ll get into this topic in detail at the end of the post…

Advocate more strongly for reductions in underlying socioeconomic disparities that limit people’s lifestyle choices and lead to health inequality (access to adequate income, jobs, education, housing and food).

Give the guy a break – you now want him to solve poverty and inequality, he’s only a TV Chef for flips sake!

Everything You Know About Everything is Wrong

Whenever you read a title stating that “Everything You Know About X is Wrong”, be prepared for some hyperbolic twisting of reality.

How and why did we reach the point where all news reports have to have sensationalist click bait headlines?

Anyway, now we can add another to the pile.

After a big preamble about scurvy and asbestos, we get to the first paragraph on the topic of obesity (hey but who am I to criticise about waffling and going off on tangent). This is just the first paragraph, but I’m going to have to take it apart sentence by sentence because there are issues in every single one!

…the medical community’s primary response to this shift (increase in obesity rates) has been to blame fat people for being fat.

“Fat people” have excess body fat because they over consume calories, i.e. consume more calories than they burn, on a consistent basis. This is an undisputable scientific fact.

There are many possible reasons why a person might do this. I am one of the first to say that it requires more than simply telling people to cut down sugar and eat vegetables. Pretty much everyone knows broccoli is good, KCF is bad, but people eat it anyway. Why they do this, is pretty damn complicated, I’ll agree 100%. How to help people change? Also really damn complicated. But abdicating people from taking personal responsibility is not part of the solution.

Obesity, we are told, is a personal failing that strains our health care system, shrinks our GDP and saps our military strength.

Are we? By who? Is this still the medical community saying all this? It certainly does put a strain on the health system, can’t argue with that. I’ve never heard the claims regarding GDP or military strength. On the contrary I’d have thought sales of junk food and diet foods, fitness fads and newer, larger waisted clothes all contribute to GDP? Drones do most of the warfare now, I’m pretty sure being overweight isn’t much of an impediment to dropping bombs on impoverished children from a great distance, but maybe I’m wrong.

Personal failing – well, again that’s a complex one, so I’m going to defer till later when I get into my own views on the topic.

It is also an excuse to bully fat people in one sentence and then inform them in the next that you are doing it for their own good.

I’m not totally sure what the “it” refers to here, or exactly what constitutes as bullying, or who is doing it.

That’s why the fear of becoming fat, or staying that way, drives Americans to spend more on dieting every year than we spend on video games or movies. Forty-five percent of adults say they’re preoccupied with their weight some or all of the time—an 11-point rise since 1990. Nearly half of 3- to 6- year old girls say they worry about being fat.

What? Again, it’s not totally clear what he’s saying here.

Is he saying that people’s fear of becoming fat is driven by the medical community’s fat stigmatisation?

Most people fear becoming fat because it sucks, for many reasons on many levels, both warranted and unwarranted, not just because their doctor might act condescendingly towards them.

Or is he saying that the medical community’s advice is driving people to “spend more on dieting every year than we spend on video games or movies”?

The aforementioned “Medical Community” recommends that people eat healthily, which is generally accepted as lots of fruits and vegetables, whole grains, lean protein, limit saturated fat and sugar intake.

Does buying fresh fruits and vegetables count as “spending on dieting”? If yes, then what’s the problem with spending more on healthy food than video games and movies?

I presume however it refers to people paying for special diet foods, diet plans, signing up to programs etc. If these work, then what’s the problem? It’s clearly justifiable to spend more on your health than you do on video games. If they don’t work, the blame can hardly be laid at the feet of the medical community who never recommended them in the first place!

Phew. Now this is a whopping article, and this is just the first paragraph, so I’m not going to go through each and every one, I’m just going to highlight the major errors – this was just to give the general idea that though it’s very nicely written, full of emotion and feeling, there is a lot to be questioned.

“Diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets”

Actually, I would say the opposite – All Diets Work! Many of them not for the reasons that their proponents claim or believe, but rather that by one means or another they restrict total calorie intake.

Many people have lost and maintained weight-loss on all of the aforementioned diets, plus via calorie counting, going vegan, plus potato and Twinkie diets.

The problem is that most people cannot stick to them, end up coming off the diet, returning to eating SAD, and in many cases as the author correctly notes, regaining more fat than they lost in the first place. He goes onto claim however that:

The reasons are biological and irreversible.

Yes, there are biological reasons for the weight regain (coupled with psychological), but these are neither innevitable nor irreversible.

Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.

I’m so glad I didn’t read this before I changed my diet and lifestyle, talk about demotivating!

Keeping weight off requires self-discipline and control. It requires sacrifice and determination, especially in the beginning, that much is true. Anyone who claims otherwise is either a charlatan, or perhaps just very very lucky.

This isn’t the case for “the rest of your life” however, but just while you lose the weight, and possibly for some time afterwards while your body adjusts to a new set point (I put just in italics, as I don’t want to diminish how challenging this can be, but it is not forever).

The second big lesson the medical establishment has learned and rejected over and over again is that weight and health are not perfect synonyms.

I covered this one above – the old “fat and fit” argument again.

The next section is a series of anecdotes about doctors giving being mean or dismissive to obese patients. He points out that:

Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice

Could it be that doctors classify fat patients as less likely to follow their advice, as they have been advising them to eat healthy and exercise, but they haven’t followed the advice?

On the one hand, I do 100% agree that doctors do not have the training, time or skill set to deal with overweight patients – at least not with regards to the topic of weight management (clearly if they present with the flu or other unrelated ailment they should get the same time and care as anyone else).

But that said, I don’t think that they should get this kind of training either!

You should go and visit a doctor to get a diagnosis. Depending upon what is wrong, you should then either be given a prescription or a referral to a specialist.

If you are overweight, you do not need a diagnosis – the diagnosis is clear, you are spending too much time in an overfed state and you need to change your diet and lifestyle. There is no need for a doctor to tell you this.

If this becomes a problem that an individual is not able to manage on their own, they should go directly to a specialist – i.e. a dietician, some kind of weight management support group, perhaps some kind of counseling.

Obesity is such a major and prevalent issue that doctors cannot be expected to take it on – they already have enough on their plate.

There is absolutely no need, nor reason, for someone to go see a doctor because they are overweight.

Physicians are often required, in writing, to prove to hospital administrators and insurance providers that they have brought up their patient’s weight and formulated a plan to bring it down—regardless of whether that patient came in with arthritis or a broken arm or a bad sunburn.

Hobbes here points out that in many cases the overweight patient is visiting for another matter altogether, but ends up getting unsolicited advice on their weight – why can’t an overweight patient just go and get treatment for a specific illness without being judged?

Why? Because it is a doctor’s job to address any serious health issues which a patient may present. If a patient arrived at the doctors with a sprained ankle, but the doctor spotted a potentially cancerous lump, would you expect him to simply ignore it? Of course not! Excess weight is known as a major risk factor for cancer, diabetes, heart disease and early death – how can a doctor possibly fail to address the issue?

Again, they shouldn’t be expected to have to give diet plans and counselling to every overweight patient – that is a full-time job in itself.

Rather obviously, smoking is a behavior; being fat is not

While of course you can’t tell someone to simply “Stop being fat”, Hobbes is ignoring the fact here that obesity is a symptom of unhealthy behaviours. Of course you can’t tell anyone to stop being fat, any more than you can tell a smoker to stop hardening their arteries or producing free radicals.

You can tell them to change their diet and exercise however.

Is this an easy thing to do? No. But neither is quitting smoking! Millions of people continue to smoke, despite being told by the medical profession that it will most likely kill them.

The problem is that in America, like everywhere else, our institutions of public health have become so obsessed with body weight that they have overlooked what is really killing us: our food supply. Diet is the leading cause of death in the United States, responsible for more than five times the fatalities of gun violence and car accidents combined. But it’s not how much we’re eating—Americans actually consume fewer calories now than we did in 2003. It’s what we’re eating.

Again, some more very nicely written emotive prose, but completely ignoring reality.

How can one possibly claim that public health institutions have overlooked the role of food and diet, when the recommendations made by said institutions to combat obesity are diet based!

Is Hobbes living in some kind of alternative reality where the public health institutions are saying “It doesn’t matter what you eat or how much you eat, just lose weight somehow, maybe by magic” – No, they are not. Again, we come back around to the issue that yes, the root of the problem is bad diet – Too many calories, not enough nutrients. Obesity comes under fire because it is a marker of this bad diet.

As for “It’s not how much we’re eating as we are eating less than we did in 2003”, this could perhaps win the prize for the most moronic statement of the whole article.

In 2003 Americans were eating WAY WAY WAY TOO MANY CALORIES. It is indeed good news that this figure has started to reduce. But they are still eating WAY WAY TOO MANY CALORIES!

It does not matter how many calories that someone consumes relative to how many they consumed in the past, or relative to how many calories consumes another person, or population. What matters is calorie balance – how many calories an individual consumes relative to their personal calorie requirement.

The average daily calorie requirement of a typical man is 2500 per day. The average daily intake in the US now is 3600. Yes, it’s a bit lower than the peak of 3800 in 2003, but it’s still over 1000 calories higher than it should be.

The rest of the article laments the shaming of poor fat people, who in Hobbes’s opinion appear to be powerless victims of Big Food and capitalism. I’m going to come back to more of his and Thomas’s claims with regards to the ideas of fat shaming and acceptance, but want to cover these topics more specifically in a second.

False Dichotomy

The first glaring fallacy with regards to the ideas of Fat Shaming and Fat Acceptance, is the presentation by both of the above authors, and many more writers on both sides of the argument, of the two being mutually exclusive.

While it is most likely true that if someone is an active “fat-shamer”, then they are probably not big into “fat acceptance”, I don’t think that the opposite is necessarily true.

That is to say, I don’t think that a refusal to endorse “Fat Acceptance” – i.e. a refusal to accept that excess body fat is healthy, doesn’t reduce quality of life, can’t be controlled via behaviour modification or will power, that beauty is in the eye of the beholder, etc, automatically makes someone a “Fat-Shamer”. It simply makes someone a realist.

Of course, this does all depend on one’s definitions for the two terms. Language is always open for interpretation.

I personally, could be classed as either or neither depending upon exactly how you define each term.

Acceptable Acceptance

With Hulme’s Guillotine still fresh in my mind from my last post, I have to make it clear that I don’t think anyone can say that people ought to be slim.

I am a libertarian. I believe people should have the right to live how they want to live, eat and drink what they want to eat and drink.

If someone decides, “I love donuts and cola so much, I want to eat them everyday and I don’t care that it will make me fat and shorten my life and healthspan”, fair enough. That is their prerogative, just as it is for someone who wants to smoke cigarettes, drink alcohol, ride a motorbike or Free Solo El Capitan.

Neither I, nor anyone else, has either the right, nor the insight into the workings of another person’s mind, to say their way of living is less valid, or that they are less happy, or less fulfilled.

While there are undoubtedly people who fit this category – fat through rational conscious choice – I think it would be a stretch of the imagination, however, to say that they are in the majority, or even a large minority.

The fact that the US Diet industry is worth €66 Billion would seem to indicate that there are a significant number of overweight people who are not happy being fat.

Now, of course one could argue that the only reason that fat people are unhappy with their weight and try dieting is because they are the victims of fat shaming, prejudice and bullying.

But personally, I don’t buy it.

I can certainly believe that these are contributing factors to many people’s desire to lose weight, and perhaps for some the primary, or even sole reasons. But to suggest that were it not for the attitudes and opinions of others, all fat people would be happy being fat despite the negative physical health and mobility effects is not only ridiculous, but also pretty insulting – insinuating that anyone who attempts to lose weight, either successfully or unsuccessfully does so only out of vanity in an attempt to please others sounds like fat-shaming to me!

Secondly, and here we get a bit more into thorny territory, we have to consider that fat people do not exist in a vacuum.

From a personal perspective, it’s all well and good choosing KFC buckets over a long and healthy life, but what about responsibility to family and friends, or society at large – what do you say to your kids when you’re diagnosed with heart disease at 50? Who compensates your employer for absences from work due to weight related conditions? Who foots the bill for medical expenses?

I’m not saying that these kinds of questions are unique to obese people, nor that I have any definitive answers. I certainly don’t want to advocate for a nanny state. I think the exact same questions could and should be applied to any other high risk behaviour.

Motorbike riding for example. People enjoy it despite the risks, though many choose to give up when they have a family, and all motorbike riders are required to have insurance.

Is riding a motorbike acceptable while you’re young and single with no dependents, but shameful when you have a partner and young children waiting for you at home? After a traffic accident, should victims in safer vehicles be given preferential treatment over those who chose to ride a “donorcycle”?

Additional Acceptable Acceptance

I can most certainly accept that some overweight and even obese people are happy with their bodies.

I think it is also important for people to accept that regardless of their desires, some people are simply incapable of losing excess body fat, at least not within the modern “obesogenic environment”.

By this I mean that both “self-righteous skinny orthorexics”, and “failed dieters” themselves have to accept this.

I.e. people who successfully control their body fat through dietary restraint have a tendency to say things like “Well, just don’t drink soft drinks and say no to dessert”, making the error that just because they can do something, so can someone else.

Equally, it may be the case that some overweight people may have to accept that perhaps they will never be able to successfully change their diet while they are constantly surrounded by endless supplies of cheap, highly rewarding calorie dense food and drink.

The MAY and PERHAPS are critical here. I’m not saying that anyone should resign themselves to an inevitable outcome. The balance between the acceptance of your limitations and the challenges that life throws at you, and the refusal to give in and keep fighting is a complex, and often mind-boggling one, but one worth pursuing (Check my post on Meditation, Contemplation and Philosophy for more on the subtle art of acceptance).

Acceptable Shaming?

What exactly counts as shaming? Can shaming ever serve a beneficial purpose? Can you shame someone for their own good?

Shame
ʃeɪm/
noun
1. a painful feeling of humiliation or distress caused by the consciousness of wrong or foolish behaviour.
“she was hot with shame”
synonyms: humiliation, mortification, chagrin, ignominy, loss of face, shamefacedness, embarrassment, indignity, abashment, discomfort, discomfiture, discomposure More
2. a regrettable or unfortunate situation or action.
“what a shame Ellie won’t be here”
synonyms: pity, misfortune, crying shame, cause for regret, source of regret, sad thing, unfortunate thing; More
verb
1. make (someone) feel ashamed.
“I tried to shame him into giving some away”
synonyms: humiliate, mortify, make someone feel ashamed, chagrin, embarrass, abash, chasten, humble, put someone in their place, take down a peg or two, cut down to size, show up;

I am in agreement with both Thomas and Hobbes that intentionally humiliating an obese person “to try to help them lose weight” is not an effective strategy. I’d also be highly dubious of the motivations behind the person doing the humiliation.

But exactly what counts as shame and humiliation, and for who, is also up for interpretation.

A doctor telling an overweight patient that they need to lose weight via diet and exercise is not fat shaming.

I can understand that this can be very difficult to hear, particularly if that person has been trying and failing to lose weight via diet and excercise for years, but it is still not fat shaming. It is an inconvenient truth. It is unfair. It is frustrating. But it is not intentional shaming.

Are there better and worse ways of delivering this news? Undoubtedly. Do doctors have the time, training and resources to handle such conversations? No! But can they just ignore a major risk factor for numerous diseases?

I am sure that many overweight patients feel shame when they are in the doctor’s office, being told that their continued failure to control their bodyweight is seriously damaging their health.  Also that this could be exacerbated by a doctor with little empathy, who can’t understand why someone can’t simply say no to their cravings. But it’s still not fat shaming in my book, it’s just a lack of tact.

Could most of us do with some more tact from time to time? Probably! But equally I think as mentioned before, we all need to practice more acceptance. If hearing the truth about yourself makes you feel shame, you either need to change your behaviour, or if you can’t, learn to accept the way things are.

True Fat Shaming, would have to take the form of deliberate intent to humiliate or embarrass someone.

Calling someone names, telling them that they are lazy or stupid, that they are disgusting or worthless, laughing at someone, or putting them down in front of other people are what constitutes shaming.

All of these behaviours are totally unacceptable, under any circumstances. Not only are they deeply hurtful, but they are also completely ineffective (if we were to believe that they were indeed intended for the recipients “own good”, which is highly doubtful).

It’s true that there are numerous testimonials out there from people who say that it was “fat shaming” that eventually led them to a healthy diet and lifestyle, resulting not only in weight loss, but in a vastly improved quality of life and well-being, but again, I don’t think that these cases really count as shaming.

Indeed, I have basically told this story myself – I think it would be a stretch to call it “fat shaming” though. Perhaps “Tubby Teasing” would be more accurate.

What’s the difference?

At the time I had a “beer belly”. I already knew I wasn’t eating well or exercising enough. I’d signed up for the gym but never went, I ate healthy meals, but also ate and drank lots of junk on the side. I was in my early 20s, and up until this point had always been super skinny, without ever thinking about what I ate.

It wasn’t, however, until a friend commented that I “Looked like a pregnant pencil”, with my skinny arms, legs and upper torso, but rapidly expanding flabby midline, that I got a sudden jolt, looked at myself in the mirror, and galvanised myself into action.

This comment was a catalyst that set me down a long and winding path, which changed my life forever in a myriad of ways, and for which I’ll be forever grateful. Perhaps without it, I wouldn’t be writing this blog. Perhaps I’d never have met my wife (who I met in the gym), perhaps I’d never of started Primal Fitness or Green Pasture Farms. Perhaps I’d never have climbed mountains or discovered Capoeira.

Perhaps.

Very likely my life would have turned out very differently without this cheeky comment.

I doubt, however, that I would have ever ended up getting fat, or never getting (back) into exercise.

I’d developed a beer belly. These things can creep up on you, seemingly from nowhere.

My friend’s comment was useful as:

1. It genuinely brought the issue to the forefront of my attention
2. I hadn’t previously made any truly concerted effort to tackle the issue
3. He knew my personality type – I’m rational, goal driven, with a thick skin

Without that comment, no doubt I would have continued with my bad diet and infrequent exercise some time longer – weeks, months, who knows maybe years. How long is impossible to know, but at some point, with or without outside commentary, I would have noticed I was gaining fat.

Where to Draw the Line

You see yourself everyday. Gradual changes such as fat gain can be almost imperceptible.

But this can only be missed or ignored for so long.

When it gets to the point where your clothes are now so tight that they don’t fit any more, and you are faced with the choice between either lose some fat, or buy a whole new wardrobe, the writing is on the wall.

If you see a good friend, who you genuinely care about and know very well, and you spot that they are starting to gain extra pounds, this is the time to broach the subject – right at the beginning.

Whether that’s with some teasing, a frank conversation, some subtle hint dropping, or simply an open conversation… “Is everything OK with you at the moment” not even directly addressing the weight itself, is totally dependent on the personalities of you and your friend and the nature of your relationship.

If it gets to the point where your friend has already had to go out and buy bigger clothes, that boat has already sailed. Your friend is already aware that they are gaining fat, they don’t need you to tell them.

Obviously, if they specifically ask you for advice, go ahead, but never just offer unsolicited diet advice to anyone. Period.

Let me also reinforce that we’re talking about good friends here, not acquaintances, work colleagues or people you pass in the street. In all these cases, just keep your mouth shut. It’s none of your business and you know nothing about that person (this should probably be extended to unsolicited advice about anything, not just diet and exercise!).

Though it may be a doctor’s obligation to tell an overweight patient that they need to lose weight, this does not mean that it is yours to go around proselytising crossfit and paleo to overweight strangers in the street. That just makes you a moron.

Thoughts on Fat Stigma

The concept of fat stigma, needs to be separated out from that of fat shaming.

Undoubtedly, fat stigma is the root cause of fat shaming, both intentional and otherwise.

It is also the reason behind many otherwise very capable overweight people getting passed over for jobs and promotions, that they are less likely to get accepted into higher education, and when was the last time you saw an overweight person in the lead role of a movie?

But where does this prejudice against people with excess body fat come from?

Hobbes seems to think that fat stigma is innate in all of us, a product of evolution:

There’s a grim caveman logic to our nastiness toward fat people. “We’re attuned to bodies that look different,” says Janet Tomiyama, a stigma researcher at UCLA. “In our evolutionary past, that might have meant disease risk and been seen as a threat to your tribe.” These biological breadcrumbs help explain why stigma begins so early.

It’s hard to know exactly what is intended by either Hobbes or Tomiyama here by “bodies that look different indicating disease risk” – whether they meant fat bodies, or just different in any possible way?

Personally, I don’t think that there’s a great deal of evidence for any kind of innate prejudice against fat bodies.

On the contrary, all the available evidence indicates that attitudes towards fat bodies are cultural, and can just as easily be positive as negative.

We have come to associate slim = beautiful, but this is not biologically hardwired into us, but rather culturally ingrained.

Mauritania is still famed for its Wife Fattening Farms where girls are sent as young as 7 to be fed up on high calorie foods in order to become big and beautiful.

Though Mauritania is now the exception rather than the rule, this wasn’t always the case. Throughout history, across many cultures, extra body fat was celebrated and coveted, for both men and women’s bodies alike, considered a sign of beauty, status and power.

Why? Because it was rare, and a preserve only of the rich.

Throughout 99.9% of human history, calories have been in relatively short supply. Only the wealthy and powerful could afford to gorge themselves on more than they really needed, so excess body fat was viewed as a sign of status.

This is clearly no longer the case, in fact the opposite is true. Calories are cheap. Excess body fat is more prevalent in people with low socio-economic standing.

If the intention in the above quote was simply “different”, how different can fat bodies be now, with nearly 2/3rds of the US population classed as overweight or obese?

A slim figure, or 6-pack abs are now status symbols precisely because they are now rare, or different.

While they may no longer be symbols of socio-economic power, they are certainly perceived as symbols of power and control over one’s own body and behaviour.

A slim and sculpted body shouts “I am disciplined and focused, I have control over what I eat and how I look. I can work hard and achieve goals“.

A fat body, however, is perceived as an embodiment of a lack of will power, greed, over indulgence, a failure to forgo instant gratification in order to achieve long-term goals.

On the one hand, I do still believe, as I wrote in the previously linked article, that “Slim People Are Never Lucky”, as they don’t have a visible warning sign that their diet and lifestyle are doing them long-term harm.

The alternative point of view, however, is that they are lucky, as their vices and foibles are well hidden.

While there may be some truth in the in the conclusions that people draw from a person’s body shape, it is a very limited picture.

A slim person may be more disciplined when it comes to food and exercise, but who’s to say they are not addicted to smoking, drugs and gambling? They might not be able to control their impulses when seeing a new pair of shoes in a store window, or spend all day obsessively checking social media.

On top of all this, they may actually have less will power and self-control with regards to food, and do less exercise, than the overweight person sat next to them – it’s just the luck of genetics that they don’t happen to store fat easily.

In this respect, I have to agree that fat people are unlucky.

If you were considering the best candidate for a job, all things were equal between two applicants but one is slim, the other overweight, who would you pick? It’s possible the slim one has issues with will power in some areas of their life, but there’s no visible evidence to suggest this. It’s almost 100% certain however, that the fat person has tried and failed to lose weight. Perhaps this lack of self-control and discipline will also manifest itself in their professional lives?

Big Fat Liar

It’s not just a lack of self-control for which fat people have become unfairly singled out – dishonesty can also be added to the list.

From Hobbes’s article:

Then, as the gathering winds down, Jessica and the other parents divvy up the leftovers. She wraps up burgers or pasta salad or birthday cake, drives her children home and waits for the moment when they are finally in bed. Then, when she’s alone, she eats all the leftovers by herself, in the dark.

“It’s always hidden,” she says. “I buy a package of ice cream, then eat it all. Then I have to go to the store to buy it again. For a week my family thinks there’s a thing of ice cream in the fridge—but it’s actually five different ones.”

Let me make it clear, I’m not saying that all overweight people partake in secret eating, or lying about their diet and exercise habits – there are of course many who are happy with their bodies, and do all their eating in the open, hiding nothing – but still, this kind of behaviour is far from uncommon.

It is also of course the case, that this kind of deception, often as much self-deception as deliberate deception of others, is again rooted in the fear of stigmatisation from cruel and vindictive fat shamers.

But it is still deception.

When an overweight person claims that they never eat sweet things, don’t binge, stick to 1000 kCals per day, etc, either they are in breach of the 1st law of thermodynamics, or they are lying.

They are lying, and everyone knows they are lying. Thus excess body fat also gets associated with deception and dishonesty.

This is yet again bad luck for fat people, as undoubtedly the vast majority of thin people lie too, about all manner of things, all of the time.

It doesn’t matter how well you hide the cookie jar, the evidence can’t be hidden from your waistline. Delete the cookies from your browser, however, and no one knows what websites you’ve been on…

The sad truth is, the lies of a slim, toned, athletic Adonis could be much more insidious than a secretly snaffled doughnut, but most likely no one will ever know.

Hobbes notes:

Surveys of higher-weight people, however, reveal that they hold many of the same biases as the people discriminating against them.

The reason that overweight people hold these same biases is because they, just like everyone else, know that they are true.

Fat people do have issues with self-control, will power and discipline, they do hide behaviour of which they are ashamed and then lie about it.

The problem with fat stigma, is not that the claims are false with regards to fat people, but rather that they also apply to the vast majority of thin people!

Almost all humans have issues with self-control, will power and discipline, and hide behaviour of which they are ashamed and then lie about it.

This is what we all need to accept, and then get over it!

Yes, there are some outliers out there who are probably perfect in every way, but they are rare freaks, and probably very boring.

Practical Stuff

So I’ve talked a lot about us being deeply flawed human beings, and acceptance – does this mean we should all just accept obesity as the norm going forwards and get on with it?

No, certainly not! Acceptance has its place, but it’s equally important to implement positive change when you have the power to do so.

I totally agree with Hobbes and Thomas that there are changes that should be implemented on the societal level – we have undoubtedly created an environment that promotes obesity, an environment that exposes our flaws and exploits them.

Where I disagree strongly with both authors, is in the belief that we should abdicate the individual from any personal responsibility, or try to obfuscate the truth that excess body fat is a bad thing.

Power to the People

Losing weight is not easy. This is the big lie of the diet and weight loss industry that has no doubt been responsible for derailing many attempts at weight loss.

If you embark on an endeavour expecting it to be easy, but it turns out to be much tougher than expected, you are destined to failure. Go in prepared, with your eyes wide open, ready for a battle, and you’re much more likely to succeed.

Weight loss may be difficult, but it can be achieved by almost anyone provided they are motivated to do so, and armed with the right information and tools.

The following would be my top tips:

• • Dieting Sucks and You Will Fail

Dieting involves a fight between your rational forward planning self, and your primal, experiencing self.

As you start to lose fat, your body will do everything it can to make you try to regain it. It will lower your metabolism, so you need to eat even fewer calories to create the same deficit, it will increase your appetite and give you hunger pangs like you’ve never experienced before, it will make you lethargic and disinclined to move to try to minimise your energy expenditure to the bare minimum.

There will be times when the cravings get too much, and you give into temptation, whether it be guzzling down a litre of ice cream, or devouring a family sized stuffed crust pizza. This is normal, and should be anticipated. Your resolve may have failed you in this instance, you lost a battle, but the war is far from over. Losing weight is a war of attrition, you just have to accept the temporary set back and get on with it.

Providing overall you maintain a calorie deficit, even the most extravagant bingeing session can only slow your progress a little, not derail it altogether.

• • Use Will Power Judiciously

I have heard it argued before that will power is useless when it comes to weightloss. The argument being that whether you resist the packet of cookies in the cupboard for 1 minute, or 3 hours, eventually you will crack, and there was no benefit for the person who resisted 3 hours. On the contrary, it would have been better just to eat the cookies straight away, and forgo the wasted mental energy and stress.

I would agree, that it is futile trying to resist a packet of cookies in your cupboard. I certainly couldn’t, and wholeheartedly agree that will power is a limited resource. The above argument, however, is seriously flawed.

You simply need to employ your will power where it is most effective – i.e. while shopping. Don’t buy the cookies in the first place. Use a shopping list, make sure you don’t shop while you’re hungry, and perhaps even avoid the supermarket altogether.

Later that evening your inner chimp might be screaming at you for cookies, but if there are none to be found, he’s not going to get his way!

• • There is no 1 perfect diet…

…but perhaps there is the perfect diet for you, and you just haven’t found it yet. Paleo fails most people, low carb fails most people, low fat fails most people, the potato diet fails most people. But each has also worked for many people. Just check the internet, it’s full of glowing testimonials for every diet under the sun.

If you tried paleo and failed, try something else. If that doesn’t work, try another. Keep going till you find something that works for you – maybe you’ll even invent a new diet, and you can become a diet guru and make millions…

• • It’s calories that count, though you don’t necessarily have to count calories

Every single diet works (while it works) because you restrict calories, either intentionally or otherwise. Famously, Mark Haub, a professor of human nutrition at Kansas State University lost 27lbs eating only Twinkies. Is it a sensible diet? No. Would I recommend it? No. But it’s an important concept to realise.

When you cut out high carbohydrate foods such as pizza, chips, cakes and biscuits, you are inadvertently cutting out calories. Same as when you cut out high fat foods such as pizza, chips, cakes and biscuits. Or when you cut out pizza, chips, cakes and biscuits because they’re not keto, paleo, vegan, or INSERT DIET NAME HERE… The real advantage of these diets is that you don’t have to count calories – more dietary restriction equals less admin!

If you don’t want to cut out any specific foods, then you’re going to have to start tracking calories. Luckily there are plenty of apps available now that will make this a lot easier. Speaking of which…

• • Keep a Food Journal

This could be a written journal, a specific diet tracking app, or via taking photos. (I’ve just now come across a new app called Bitesnap which appears to do everything in one, though have never tried it)

Eating is a largely automated process, and as a result, we often don’t consciously register many of the things we eat. It’s estimated that at best we are aware only of 80% of the foods we consume, though with overweight and obese individuals this tends to be much lower.

Numerous studies have shown that by simply keeping a food journal, with no other dietary recommendations, many people spontaneously reduce their calorie consumption and begin to lose weight!

• • Eat Protein

Whether you restrict calories, carbs, fats or all three, keep protein high. Protein is highly satiating, and will reduce hunger – hunger is what causes most weight loss attempts to fail in the long run. This is one of the main reasons the Twinkie diet is such a bad idea, as they are not satiating at all (plus devoid of any nutrition). Even with a high protein diet, you are still going to get hungry, you will still have cravings, but they will not be as bad.

• • Eat Vegetables

Vegetables are also satiating, plus packed full of vital nutrition. You can eat vegetables until they come out of your ears and they will not lead to fat gain. Unlike cookies, they are also safe to keep stocked up in your cupboards – no one ever raided the broccoli drawer in the middle of the night!

• • No Food is a Sin

Many fad diets are highly dogmatic, categorising foods as either indispensable or evil. Bread is evil, dairy is dangerous, sugar is a sign of weakness in the soul… This is all nonsense. Yes, too much of any of these foods is bad, but if you eat plenty of lean protein and vegetables, you can include sweet and savoury treats and still lose fat, providing you maintain an overall calorie deficit.

• • Go Slow. Or Fast

You’ve probably heard that the optimum rate at which to lose fat is around 1kg per week. Well someone probably just plucked that out of their… thin air.

Studies have actually shown no difference in success rates between rapid fat loss diets, or slow and steady fat loss diets. Which is best for you probably depends upon whether you’re the type to rip off a plaster or peel it off slowly – i.e. it’s a personal thing, there’s no right or wrong answer.

• • Did Someone Say Fast?

Intermittent Fasting is also an approach to consider, with a growing body of research behind it. It could be done in isolation, or in conjunction with another diet. Again, it’s not for everyone, but it’s worth trying a 24 hour fast at least once, just to acquaint yourself with true hunger. Check my IF articles here and here.

• • Have a Maintenance Plan

Most diets fail, not because people don’t lose weight, but because they regain it afterwards.

They regain the weight because they either go back to eating the way they did beforehand, or find ways to cheat their diets with “Paleo Cookies” or “Low Fat Cakes”, thus going back into a calorie surplus.

A common claim is that you need to find a diet that you can stick to for the rest of your life – but this is not true, and in my opinion potentially very demotivating!

To lose weight, you need a diet that puts you in a calorie deficit. You are essentially starving yourself. Your body is aware of this, and no matter how optimum the diet is for your genetics and your personality, it’s going to suck.

You will be hungry, irritable, lethargic a lot of the time. Not all of the time as Hobbes might believe, but some of the time. Worse, you’re going to be surrounded by delicious high calorie temptation pretty much 24 hours per day. No one could withstand this for their entire lives.

The good news is that you don’t have to. If you did, you’d eventually die of starvation. What you need is a maintenance plan. A diet that puts you in equilibrium – the same number of calories in as out.

• • Stick to the Maintenance Plan

Hobbes is wrong that you’ll have to live with hunger for the rest of your life. But you will have to put up with it for a while. Again, I’m not saying weightloss is easy!

Even though a maintenance diet should have you in calorie equilibrium, your body will want to return to its “set point”. Your body has had all its fat cells raided, and it wants you to fill them back up again now that the “famine” is over (Your body has no idea it was a self-imposed calorie restriction).

Eventually not only will your set point readjust to your new weight, but also your metabolism will pick up again, and you’ll gradually start to be able to increase your calorie intake.

• • Join the Resistance

Resistance training has been shown to significantly reduce muscle loss during dieting. Dieting alone typically results in the loss of lean tissue as it’s very metabolically active – if you don’t use, it you lose it…

Just 1 or 2 short session of High Intensity Training per week can help maintain your muscle mass, thus keeping your metabolism higher (more calories burnt) and ensuring that the majority of your weight-loss comes from fat.

• • Get Active

The more you move the better. Just as with diet though, there’s no one perfect form of exercise.

Try lots of different activities – hiking, running, football, yoga, crossfit, capoeira, zumba. The best one is the one you enjoy the most, and so will stick with.

Also, try to incorporate as much NEPA into your days as possible – i.e. walking and cycling instead of always relying on cars and public transport.

Change the World

I am in 100% agreement with Hobbes and Thomas (and Jamie Oliver!), that the current obesity epidemic has been caused by environmental changes and social inequality.

People have not become fatter because they have suddenly become lazy or greedy, but because high calorie, low quality food has become cheap and ubiquitous.

Yes, we need to work towards a world where everyone has a top class education, and everyone has the time and money to buy and prepare healthy, fresh, nutritious food.

We should also perhaps look to ending the subsidies to crops such as corn which help make HFCS and industrially raised meat so cheap, either scrapping them, or switching them to healthier more sustainable crops like fruits and vegetables.*

A ban on advertising would also be welcome. At the very least of junk food to kids, or better junk food full stop. Or perhaps just food advertising in general to save arguments over what counts as junk (and I don’t recall ever seeing a TV advert for a vegetable anyway!).

Healthy school meals, and educating children on good nutrition you’d think would also be a no brainer – That the UK and the US, two of the richest countries in the world feed their school children on chips, pizza and chicken nuggets is pretty mind-boggling.

All these things, we certainly need to work towards, and we should be grateful that we have icons such as Jamie Oliver helping to campaign for them.

These changes aren’t going to happen overnight, however, and though it is deeply unfair that we live in a world that makes it extremely difficult for many people – in fact, the majority of people – to control their weight, this doesn’t mean that we can just pretend that it’s not an issue, nor demand that people also take some personal responsibility for their health.

*One final point to nitpick with Hobbes article would be the accusation that healthy food is vastly more expensive than junk food. Yes, if you compare cost per calorie, kale is going to seem vastly more expensive than cake, but this comparison ignores A) That there’s a lot more to food than just calories, and B) most people actually want to reduce calorie consumption.

An apple and a mars bar cost around the same price. Yes, the apple is much more expensive per calorie, but it’s also much cheaper if you compare cost per RDA of vitamins, minerals or fiber! Swap the mars for an apple, it’s not cost you any more, you’ve reduced your calorie consumption which was your aim, plus you’ve upped your nutrient intake and it’s probably more satiating! Win win win.

Yes, it would cost you a lot to try to meet your daily calorie needs via organic cucumber, but a diet comprised predominantly of vegetables, potatoes, legumes and wholegrains, supplemented with some high quality animal foods such as oily fish or pastured meat once or twice a week can be maintained on a very modest budget, and could even save money.