He Said, She Said: My Big Fat Fabulous Life

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In a recent episode, of My Big Fat Fabulous Life, the protagonist visits her alma mater where she gives a talk about body positivity and then fields questions from students. Who knows what really went on in that auditorium, but if we take the video at face value, she did a fine job of responding, especially for a layman who was put on the spot. With time and expertise on our side, we took our own stabs at answering two of the questions that arose.

 

He Said

“The medical community actually agrees that obesity can lead to a shorter life span. Do you think that your No BS [No Body Shame] campaign, which emphasizes feeling confident and beautiful at any size, do you think that that can coexist along with the very real facts that they do cause legitimate health concerns?”

The premise of this question is faulty in a few different ways.

No, the medical community does not agree that obesity can lead to a shorter life span.

Research actually suggests that other factors have a greater impact on mortality than does body size. For example, a 2012 study by Matheson et al. looked at the impacts of consuming five or more fruits and vegetables daily, exercising regularly, consuming alcohol in moderation, and not smoking and found that mortality was virtually identical across all studied body mass index groups when subjects had all four healthy habits. In other words, when it comes to our risk of dying early, behaviors are a better predictor than is body size.

In his 2010 study, Fogelholm found that physically active obese individuals had better cardiovascular and all-cause mortality risk than sedentary “normal weight” people, again suggesting that when it comes to matters of life span, behavior is a more important factor than is body size.

The entire body of research is bigger than just two articles, and of course, not every study reaches the same conclusion, which reinforces how much we still have to learn and underscores how inaccurate claims of universal agreement within the medical community are regarding this complex topic.

Size acceptance and health are two separate issues.

“The mission of the No Body Shame campaign,” according to its website, “is to help every individual overcome the debilitating effects of societal-induced shame. Supporters of No Body Shame have named weight, height, skin color, sexual orientation, gender, different abilities, and specific physical attributes as causes of shame. Whitney believes that when we commit ourselves to living our best lives now, accepting ourselves as we are even if others do not accept us, real changes in confidence and quality of life are not only possible, but imminent.”

Note that nowhere in the mission statement does health appear. No BS is part of the size acceptance movement, which is related to, but not synonymous with, initiatives like Health at Every Size (HAES®) that promote a paradigm shift within the medical community to focus on actual health instead of weight.

In explaining size acceptance, Ragen Chastain writes, “Everybody deserves basic human respect and civil rights and that should never be up to show of hands or vote of any kind. Fat people have a right to exist, there are no other valid opinions about that. Our rights to life, liberty and the pursuit of happiness are not someone else’s to give, they are inalienable. SA [Size Acceptance] activism is not about asking someone to confer rights upon us but rather demanding that they stop trying to keep them from us through an inappropriate use of power.

HAES, on the other hand, can be succinctly encapsulated as a weight-neutral approach to health. The Association for Size Diversity and Health (ASDAH) elaborates by saying, “The framing for a HAES approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being.

While size acceptance and HAES are different concepts, clearly they relate. The situation is more complex than I am about to make it seem, but for the sake of brevity, consider how weight stigma pushes people into weight-loss pursuits that are most likely to worsen their health. If we as a society are more accepting of people of all sizes, we free each other up to instead focus on our actual health.

The implication that feeling unconfident or unbeautiful at certain sizes inspires better health is the exact opposite of what tends to actually happen.

Tomiyama and Mann conducted a study in which they posed two sets of questions to different subject groups. One set of questions was designed to make the subjects aware of weight stigma while the control questions asked about ecofriendly behaviors.

After subjects answered their questions, researchers presented them with a variety of foods and gave them permission to eat whatever and however much they would like. The people who had just responded to questions about weight stigma consumed significantly higher amounts of sugar and calories than those who answered neutral questions.

Their findings mirror our clinical observations and experiences. People often believe that self-dissatisfaction will somehow inspire better health, when in reality the individuals who love and accept themselves as they are tend to be the ones motivated to take better care of themselves.

Correlation is not synonymous with causation.

The questioner ended her inquiry with, “the very real facts that they do cause legitimate health concerns.” The context suggests that she misspoke when she used the word “they” and was actually referring to obesity.

If that presumption is indeed correct, then she is confusing correlation and causation. Earlier this month, I watched a fireworks display one evening and then a parade the next morning. Did the fireworks cause the parade, or did these events occur in close proximity to each other due to another factor, say, Independence Day?

Similarly, when we consider the diseases linked to obesity, we must remember that correlation does not equal causation. The link, in other words, might not be a causal relationship, but rather an association due to other factors. Many examples exist, but for the sake of brevity, consider just one: stress. Cardiovascular disease, which is often blamed on obesity, is also associated with life stress.

If you are not obese yourself, do your best to put yourself in those shoes for a moment: You live in a society where the government has declared war on your body size; where fat hate and bullying are prevalent online and in real life; where you might fear going to the doctor because you are more likely to receive a judgmental directive to lose weight rather than an actual evidence-based medical intervention; where commercials, memes, advertisements, talk at the gym, the grocery store, and over the dinner table hammer at you repeatedly throughout the day, every single day, that something is wrong with you and it is your fault. Tell me, how is your stress level?

 

She Said

“My father passed away this past April. He was severely overweight, he was diabetic, and he was an avoider, right. Do you think there is an ethical concern in folks who view you as a health and fitness expert or at least a public figure and use that body positivity message as an excuse to avoid actually addressing their real health concerns?”

While the second sentence of this audience member’s question is not a question at all, I think it needs to be addressed. Although he didn’t specifically say so, this statement reads as though the questioner believes that his father’s weight was to blame for the development of his type 2 diabetes (T2D). As we have discussed numerous times before, weight and health are two very different things and that while being “overweight” or “obese” might be correlated with certain health conditions, such as diabetes, there is no evidence that being “overweight” or “obese” causes these conditions.

In a 2012 interview for the Health at Every Size blog, author Linda Bacon explains, “while it’s true that the majority of people with T2D are in the BMI categories of ‘overweight’ or ‘obese,’ that’s at least in part because the insulin resistance that underlies most cases of T2D often causes people to gain weight. In fact, weight gain may actually be an early symptom—rather than a primary cause—of the path toward diabetes.” In addition, Bacon cites a “review of controlled weight-loss studies involving people with T2D” which showed that while “overweight” or “obese” individuals with T2D had initial improvements in their blood sugar levels with weight loss, those levels eventually returned to baseline within 6 to 18 months, even for those few individuals who had managed to keep the weight off.

I also think it is important to look at the way that the questioner described his dad: as an “avoider.” That tells me that this man believes that his father did not take care of himself to the extent he could have in order to have prevented his untimely death; that if his father had not “avoided” his health issues by presumably eating better and losing weight, he might still be here today. That seems like a very serious assumption. Sometimes even when people take all the right steps in dealing with their health condition, they will still pass away. We all like to think that if we eat perfectly, don’t smoke, don’t drink, and do all the “right things” (i.e., healthy life behaviors), we will live forever. Unfortunately, none of us is immortal.

Now to address the actual question that was asked. I find this question problematic for a couple of reasons. First, I don’t think that Whitney (the protagonist of MBFFL) has ever tried to portray herself as a “health and fitness expert.” Over the first 3 seasons, she has consulted with a registered dietitian who practices Health at Every Size® (HAES®), has seen a cardiologist, and has been working with a personal trainer in addition to other health professionals. She herself admits that she struggles with the health and fitness part of her life, particularly in that she battled an eating disorder for much of her teens and twenties. She has never presented herself as an expert in nutrition, fitness, or medicine.

The second reason I find the question problematic is that the questioner assumes that the message of body positivity is being used as an excuse for people of size to avoid dealing with their health issues. This is simply untrue. Body positivity is about seeing all bodies as “good” bodies, that no one body type is the “ideal,” regardless of what our society (particularly the media) likes to tell us. In other words, the body positivity movement says “there is no wrong way to have a body.” It also recognizes that “good health” is not a requirement to have a body and that sometimes (due to circumstances outside of one’s control) our bodies might not be healthy. This does not mean, however, that these bodies are any less good.

At the end of the day, I think the best way to think about this question is through the lens of the “Underpants Rule,” coined by the brilliant blogger Ragen Chastain of Dances with Fat. Ragen defines the rule as such: “everyone is the boss of their own underpants so you get to choose for you and other people get to choose from them and it’s not your job to tell other people what to do.” This means that others do not have a right to tell you how you should take care of your body and vice versa. Whitney has never told her viewers (at least to my knowledge) how they should be treating their health conditions – she is only focusing on her own body and health issues.

Body positivity does not assume that everyone is actively trying to be living their healthiest life. It is more about helping people realize that skinny bodies are not the only bodies that are worthy or beautiful. Yes, some individuals might show love for their bodies by trying to take care of them by eating a varied, nutritious diet, being physically active in an enjoyable way, getting enough sleep, and managing stress. But not everyone is able to engage in all of these behaviors. The body positivity movement says that even if one is not in the best of health, their body is still valuable.

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