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Babies and Bathwater —

January 12, 2015

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Trigger warning: Discussion of weight loss, weight loss surgery and diet talk.

Over the past five years, I’ve done a number of book reviews, both fiction and nonfiction. I’m not a huge fan of doing book reviews because once I agree to review a book and receive the review copy, I begin to feel a kind of pressure. Almost all the books I review are written with a Fat Acceptance (FA) or Health at Every Size® (HAES) perspective and, as such, I feel pressure to positively promote the work of my fellow writers.

And yet, I hold myself to a ridiculous standard of intellectual honesty. I’m not going to promote a book that isn’t worth my time or yours. Personally, that’s a fairly high bar because I am the world’s slowest reader and any investment I make in reading a book feels pretty significant for me.

So there have been times where I’ve begun reading a review copy of a book and found it either dull or uninformative or terribly written, at which point I decide it’s not worth it. If I can’t get into a book, I’m not going to continue reading it, but, more importantly, I’m not going to review it.

The reason I don’t write a negative review of FA or HAES books is simple: as a relatively small community of activists, we simply can’t afford to shit on each other. Yeah, I might not find Book X useful, but others may find it riveting. So if I write a negative review of Book X, I may discourage people from discovering a work that, from another’s perspective, is invaluable.

I consider it a favor to the author that I’m not going to say a single negative thing about something that they’ve worked so hard on. I know how much time, energy and love goes into writing a book, so the last thing I want to do is discourage anyone from writing about self-love and self-acceptance, a subject which needs more writers, not less.

And yet, there are books with which I have a complicated relationship; there are parts that I love and parts that I’m ambivalent about at best. For example, I was recently asked to participate in a “blog tour” by writing a review of Body Respect by Linda Bacon and Lucy Aphramor. I love how the book attempts to incorporate the social determinants of health (SDH) into the HAES world, something I have personally been discussing for years.

But something about the way the authors framed the SDH in relation to personal health choices rubbed me the wrong way. In my view, HAES has always implicitly incorporated the SDH into practice by tailoring health behaviors to individual circumstances. Or, to quote the original Bull Moose:

Do What You Can

In my view, the new framing in Body Respect made it sound like personal health behaviors are futile in the shadow of the SDH, a viewpoint I cannot agree with entirely.

And so, about halfway through the review, I raised those questions that I felt were unanswered as a way of laying the groundwork for an interview I had scheduled with Aphramor a few weeks after the review was published. I felt like I had given their book an overwhelmingly positive review, while raising some important questions for the future of HAES.

Apparently, the authors felt differently.

Bacon contacted me the next day and told me that she felt that my review was disrespectful because I critiqued their book during their blog tour. Presumably, I should have saved my criticism for a later date. Bacon then asked that I either delete my review entirely or else remove any reference to Body Respect from the review.

Concerned that I had violated my own cardinal rule of “do no harm” in promoting books, I consulted several people I greatly admire and respect — people who will happily tell me I’m full of shit — and asked if I had possibly been too negative or discouraging of the book. Each person told me my critique was even-handed and fair.

And so, I told Bacon I could not in good conscience delete my review. I felt my critique was an important part of the discussion of HAES and the SDH, and that it would reflect poorly upon my editorial judgement to remove it.

As this back and forth continued between Bacon and I, both Bacon and Aphramor posted the following comment on my review:

It’s understandable why SDH and self care get so polarised from the cultural starting point we have in constructing health narratives. Lucy’s got an interview with you scheduled, perhaps this could be a fun topic to delve into.

I had been quite concerned that my decision to stand firm on the review would negatively impact my relationship with Bacon or my interview with Aphramor. This comment reassured me that I had raised a valid point that could be discussed more thoroughly in a robust discussion of HAES and the SDH.

But then, a few days before I was supposed to interview Lucy, she sent me an email informing me that she “decided to leave the conversation now.”

And that was that.

My questions would not be answered, my concerns would not be addressed. It seemed that in their view my review was so negative, so hostile, so harmful that I no longer deserved an interview.

Even though I could not agree that self-censorship was the appropriate solution, I did contact their publisher and request that my review was removed from the blog tour so as not to negatively affect their promotion.

When this first happened back in September, I had intended to write about it immediately. But those same trusted advisers recommended I not rush into anything, that I not cut off my nose to spite my face.

And for a while, I agreed.

There was still a “do no harm” principal at stake and I felt that there was no legitimate reason to mention Bacon’s attempt to persuade me to censor myself. I understood that she was simply protecting a project that she and Aphramor had worked long and hard to produce, and from their perspective, my review may have tainted the promotion they were expecting.

But since then, something has changed.

In October, Rebecca Jane Weinstein released her book, Fat Kids: Truth and Consequences, a project she’s been working on for years. It’s a kind of follow-up to her previous book Fat Sex: The Naked Truth (a book I reviewed, BTW).

I’ve personally seen how much time and energy Weinstein has poured into both of these projects, which she passionately felt needed to be covered. In a world where stigmatizing fat kids is seen as a means justified by the ends, it’s invaluable that someone would dedicate years interviewing subjects and sharing their sometimes traumatic, sometimes uplifting stories .

For a book focused on such a specific subject as fat kids, Weinstein covers a broad spectrum of issues from forcing kids to diet to the cost of being a social outcast. It’s a thorough examination of the subject, and includes diverse perspectives, as well as fascinating contributions from FA thought leaders like Peggy Elam, Pattie Thomas, and Daniel Pinkwater.

It’s an anthology of sorts, with each chapter contributing a piece to the overall mosaic of life as a fat kid. It would be incredibly cynical and myopic to take a single chapter and base an entire recommendation off of it. And yet, that’s exactly what happened to Fat Kids.

Wann

Indeed, the chapter in question is not from a HAES-friendly physician. It’s a Q&A with Emily Dhurandhar, assistant professor in the Department of Health Behavior at University of Alabama Birmingham and chair of The Obesity Society Advocacy Committee.

It’s a mainstream perspective on childhood obesity. Does it comport with FA or HAES? Not exactly. But the fascinating part is that it’s the perspective of a mainstream researcher which includes elements widely understood and accepted in FA and HAES circles: namely that stigmatizing fat people is a terrible way to promote health.

At no point does Weinstein frame this interview as reflective of HAES. In fact, she explains that this is a controversial chapter with a controversial perspective (at least when viewed through a HAES lens). As Weinstein says, “In this interview, we are given essentially a primer on weight from the perspective of a clinical obesity researcher.”

Is this chapter meant to change how HAES views childhood obesity? Nope. Is it meant to convinced readers that fat is a disease? Nope. Although Dhurandhar says that she believes obesity is a disease in “some cases,” her opinion raises more questions than it answers (e.g., how can something be a disease just some of the time?). It’s a discussion with someone outside of HAES circles whose research validates significant portions of HAES, like the idea that “treating obesity” is as simple as calories in/calories out.

If you overeat, what your body chooses to do with those extra calories is less clear. But we do know that in general, if you eat less than you should to maintain your current weight, you generally will get hungry and eat more.

But where Dhurandhar’s view conflicts with HAES, Weinstein asks critical questions, as with regard to pregnant women who have had weight loss surgery. She doesn’t simply accept Dhurandhar’s answers, she probes her for greater clarity. Personally, there are more questions I would have raised in the interview to distill her view further, like whether weight is an independent risk factor when a subject’s fitness is accounted for. But Weinstein does her best to question the assumptions Dhurandhar makes.

In general, Dhurandhar’s own view seems conflicted. She believes that in extreme cases of metabolic disorder, caloric restriction is the only means of treating the child, but not in cases where the child is simply heavy. Even her claim that obesity is a disease is framed as dependent upon comorbidities.

Again, is this HAES? Nope. But at no point does Weinstein present this chapter as representative of HAES.

But the great thing is that there’s another chapter that serves as a direct response to Dhurandhar’s claims. Titled “Collateral Damage in the ‘War on Obesity,’ Peggy Elam eviscerates the “fat as disease” paradigm and acts as a deeply-sourced check on Dhurandhar’s interview.

In the context of the full book, we are presented with two sides of an argument on childhood obesity and readers are left to decide where the truth lies. If you’re a cynic, then you don’t trust readers to find Elam’s arguments compelling enough to serve as an adequate response. But I’m of the mind that readers are capable of digesting complicated, nuanced arguments and finding the truth without being led by the nose.

Not every FA/HAES book needs to present all your answers neatly packaged in pre-approved format. In fact, FA/HAES books can be quite effective when raising questions that challenge both the mainstream view, as well as our own. To fear anything short of obeisance shows cowardice, in my opinion.

As a result of Wann’s criticism, multiple commenters said they would not buy Weinstein’s book. As a de facto gatekeeper of Fat Acceptance, Wann’s disendorsement directly discouraged people from supporting a project that serves as a powerful testament to the damage of mainstream views on fat kids.

And then Linda Bacon threw her two cents in:

Bacon

Weinstein’s comments are no longer there, but at the time I copied the text because I found the exchange disturbing. Bacon references this response to Wann in which Weinstein explains what’s in the book:

There is a highly critical chapter on a residential school for “overweight” teens, one on stigma and another on eating disorders. Marilyn, Linda Bacon, Ragen Chastain, and many others in the “movement” are discussed and quoted. There is also the interview with Daniel Pinkwater.

I’m not exactly sure how Weinstein was being disingenuous here, as she mentions Wann, the very person who says she wouldn’t read more than a single chapter. Weinstein never claims that Wann, Bacon or Chastain agree with her or that the book is “congruent” with their ideas, just that she included discussions of those thought leaders elsewhere in the book.

Regardless of whether you agree with Dhurandhar or not, it’s clear that the chapter isn’t an FA or HAES perspective. But it’s also not exactly “all fat kids are diseased and need to diet” either. So, the question seems to be what purpose does this interview serve the book?

In my view, Weinstein seems to be present Dhurandhar’s viewpoint as an objective figure who is not personally vested in HAES or FA. This is a problem in Wann’s estimation:

The book positions this particular scientist as the authority on questions of science and health… There are certainly laboratory scientists available who don’t view fat people as diseased and in need of a cure. There are certainly laboratory scientists who know about and opt for a Health at Every Size® approach, who show concern about how their work participates in or challenges weight oppression, and who are knowledgeable about the psychological impact of the weight=health belief system. The author chose to present as an expert on fat kids someone who did not have those points of awareness.

The implication seems to be that any author who wants to discuss weight-based oppression must only present HAES-friendly experts. While I understand the need for books with HAES-friendly views, to make such standards a litmus test for fat-friendly media is awfully short-sighted.

I don’t think anyone can question my commitment to promoting HAES as the best evidence-based approach to healthcare, but what kind of advocate would I be if I completely ignored people who did not share my perspective? In my interview with Harvard’s George Blackburn, I found much common ground with someone widely regarded as an expert on public health policies. Was I only supposed to interview HAES-approved public policy experts? What kind of advocate would I be if I can’t converse with those I disagree with and share both perspectives? Are our beliefs so fragile, so frail that they cannot withstand the examination of diverse perspectives?

The thing is, someone like Emily Dhurandhar might be really receptive to a HAES perspective (as Blackburn seemed to be), but far too often we’re so recalcitrant that a real conversation with mainstream experts is over before it even begins. There is no “authority on questions of science and health” that a book-writer can cite and ensure 100% agreement from the rest of the medical community.

What there is, however, is a preponderance of evidence that eventually persuades a majority of the medical community to view one perspective is more valid than another. And that evidence exists, regardless of the context we try to put it into.

What I saw in Dhurandhar’s interview was some really great information on the evidence that she’s aware of that weight is far more complicated than calories in/calories out. That information was spun to fit her own weight-centric worldview, but that worldview, in my reading, seemed to be one more concerned with the extreme ends, rather than the vast majority.

I think it’s incredibly disingenuous to suggest that there aren’t health problems at the extreme ends of the BMI bell curve. What I thought I had learned from HAES is that health is complicated; sometimes weight can affect one’s health at the extreme ends, but weight is not as central to health as the weight-loss industry wants us to believe.

Dhurandhar’s view was seemed like the weight-centric version of that viewpoint, as though gazing back from the other side of the HAES looking glass. And she’s mainstream. So if you read the entire book, I would imagine that setting that interview beside Elam’s epic review of the evidence in favor of a weight-neutral approach like HAES, a person would have enough context to see that being shitty to fat kids does more harm than good and does not result in fat kids becoming skinny kids.

And here’s the thing: Weinstein requested that Peggy write her chapter as a response to Dhurandhar.

Elam

Neither Wann nor Bacon read Elam’s chapter. A single chapter was enough to dismiss an entire book that Weinstein poured her heart into. With a single Facebook post, Marilyn Wann convinced countless people to not buy Fat Kid, and Bacon cosigned that view.

I’m not here to say that nobody should criticize problematic fat media. Far from it. I began this post explaining my own trepidation at daring to stick by my criticism of Body Respect. But I would hope that rather than attacking a reliable ally for publishing something we disagree with, we could open a dialogue on whether conflicting viewpoints are worth exploring. I find it incredibly disturbing for such prominent leaders in FA and HAES to swat a book out of the air because they found something disagreeable in its content. Fat Kids deserves better than that.

Instead, the attack on Weinstein’s work seems like petty sabotage that has literally impacted the livelihood of a longtime promoter of FA and HAES. Does the context of Weinstein’s history mean nothing? Does a single perceived misstep really justify the social media equivalent of the stockade?

It’s this kind of reactionary litmus test that drives people away from FA and HAES. Can you imagine investing hundreds of hours of time conducting interviews and going through the painstaking writing and editing process, only to have one of the most influential fat activists essentially give you the hook?

The Hook

It’s a shitty move.

But what really bothered me, more than anything, is the way Bacon insisted that I respect the promotional stage of her book, while simultaneously twisting the knife in Weinstein during her promotion. If you’re going to hold people to a strict standard of mutual interest, then I expect you to do the same. Anything less smacks of hypocrisy, in my opinion.

Since I first began blogging, I’ve felt like an outsider in the Fatosphere. It’s almost like reliving high school, where you must affiliate with a popular group or else be excluded from participation. That exclusion discourages people from contributing their voice to the chorus of self-acceptance, and it will ultimately force out people who may otherwise be useful to a small, but vital movement.

The saddest part of all this drama is that because of a few loud voices, many people won’t give Fat Kids a chance, and they’re going to miss out on some important, moving stories that shed a much needed light on the collateral damage from the War on Fat. But I guarantee that if you are willing to look past the controversy and keep that one chapter in perspective, you will not regret owning a copy of Fat Kids.

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17 Comments leave one →
  1. January 12, 2015 11:24 am

    Honesty and authenticity will take us further as a community than blind agreement. We’ve seen some nasty examples of that in history and should try to keep ourselves open to change. It’s that openness that allows us to even consider that it’s okay to be fat. Thanks, Atchka.

  2. vesta44 permalink
    January 12, 2015 12:00 pm

    I’ve noticed, over the few years that I’ve been involved in FA, that there’s a “party line”, of sorts, and if you aren’t willing to toe that line, you don’t really get very far in the FA movement. All you have to do is piss off one of the “leaders” and everything you’ve done in the past , no matter how helpful to FA, is suspect, and everything you do from then on is viewed with suspicion, if not outright derision. It’s no wonder that people get burnt out, get discouraged, and decide to just say “Fuck this shit, I’m tired of trying to please everyone and ending up pleasing no one.” It’s like they’re trying to make the FA movement a matter of black and white, and not allow for the many shades of gray that exist. Ignoring those shades of gray loses allies and keeps the movement from making as much progress as it otherwise could.
    All of the disagreements over who belongs in FA, who can be an ally, does nothing but divide us. It pits us against each other, more than just thin vs fat – it’s in-betweenies vs superfats, “healthy” vs “unhealthy”, “good” fatties vs “bad” fatties. And as long as we’re divided in these ways, we’re not going to be able to convince the fat people who aren’t yet on board with the FA message to join us, let alone convince those who society deems “normal” to agree with our message and finally see that we who are fat, to whatever degree, have the same right to exist, laugh, love, work, and play as everyone else, without fear, shame, blame, and loathing following us.

    • January 12, 2015 12:58 pm

      Yep. I saw such behavior just a few months ago, from one of the movement’s “important people” not referred to anywhere in atchka’s current piece above. They way overreacted to a poster’s disagreement and tore their supposed lesser a new one for no good reason. I had often enjoyed reading this particular “important FA/HAES blogger” but had never dared to comment on their site for fear of exactly such a thing happening to me. When I read the out-of-whack exchange, I could feel the hot-cold sensation up and down my spine which always precedes a fight-or-flight response for me either online or off. I backed out of there at about 100 mph and never went back. DX

  3. Theresa permalink
    January 12, 2015 12:31 pm

    Thank you so much for this blog. I was so disappointed in Marilyn and Linda both for attacking Rebecca’s work without reading it.

    Folks, I have read “Fat Kids.” It’s fucking brilliant. Buy it. Seriously.

  4. January 12, 2015 1:01 pm

    I appreciate your forthrightness, Shannon. This one paragraph really stood out for me, however.
    “I think it’s incredibly disingenuous to suggest that there aren’t health problems at the extreme ends of the BMI bell curve. What I thought I had learned from HAES is that health is complicated; sometimes weight can affect one’s health at the extreme ends, but weight is not as central to health as the weight-loss industry wants us to believe.”
    I feel the same way. The one thing I try to point out is when people think it’s somehow okay to be nasty to those on the extreme ends of the curve, it is not okay ever, and it makes you a complete douchebag if you do.
    Sadly, there seems to be a lot of infighting in the HAES/SA/FA communities. I had to back off from participating for a while because I just couldn’t deal.

  5. January 12, 2015 1:55 pm

    I will simply say thank you.

    • Diane McRae permalink
      January 12, 2015 10:29 pm

      And I will echo that!

  6. Sophie permalink
    January 12, 2015 6:06 pm

    Thanks Atchka, a true blue, ‘freethinker’.I will make up my own mind, I don’t need Bacon and Wann to gatekeep and set the agenda.

  7. Lizbeth permalink
    January 13, 2015 9:58 am

    Refreshing and well-written article, Shannon. I’d recommend posting it on Amazon for Body Respect. Sometimes “outsider” status is what it takes to see the dysfunction in something. And Fat Kids is a terrific book; let’s hope it finds its legs with discussions like this.

  8. January 13, 2015 4:27 pm

    You did good Shannon. Well written and presented better than the stew of frustration I’ve had in my mind over this. Re-posting now.

  9. lifeonfats permalink
    January 13, 2015 6:37 pm

    The superior “Mean Girls” attitude of certain bloggers and the hive mind comment section is a major reason of why I quite reading and following so many sites. Those that presented another view, who weren’t trolls, and supported the movement, were thrown so much shade that the skies would have been cloudy for weeks. We don’t need that drama and a lot of it is very petty and can be worked out maturely. It doesn’t help the cause when the big voices in FA, pardon the pun, are straight, middle-upper class white women. After so many years, we are still not as inclusive as we should be.

  10. Razza permalink
    January 14, 2015 6:41 am

    It seems strange also that the HAES blog has a series of interviews called Building Bridges

    “Welcome to another “Building Bridges” post, in which we feature interviews with health professionals, academics, and policy makers who are not necessarily identified with the Health At Every Size® movement. While some of our readers may experience our choice of interviewees as controversial figures with viewpoints that are at odds with the genuine promotion of size-acceptance and/or the Health At Every Size principles, we believe that aspects of their work contribute to the overall HAES® conversation and are thus valuable to HAES proponents as we attempt to address issues such as weight stigma, intersectionality, health-care access, research, policy development, and politics, among others. We encourage readers to respectfully ask questions, agree, challenge, and/or share your own ideas on the content of these interviews. Our overarching goal is to engage in meaningful dialogue around differences, in the hope of increasing our overall understanding and effectiveness in moving the HAES approach forward.”

    So it’s seems like it’s ok when the HAES approved blog does it, but not when someone else does it.

  11. January 14, 2015 1:41 pm

    Thanks, Shannon. I must say it amuses me to see you refer to my chapter in Fat Kids as “epic,” given that the original version I submitted to Rebecca was about twice as long! (I’d waaay overestimated the length she wanted for the book.) Right after I submitted the chapter my mother broke her hip and so I turned the editing/trimming over to Rebecca, not having time to do it myself. She did an excellent job. IMO most of the rest of the book anecdotally confirms the harm done by weight-focused approaches.

    You mention that you “think it’s incredibly disingenuous to suggest that there aren’t health problems at the extreme ends of the BMI bell curve. What I thought I had learned from HAES is that health is complicated; sometimes weight can affect one’s health at the extreme ends, but weight is not as central to health as the weight-loss industry wants us to believe.”

    Yes, health is complicated. And we are often subjected to erroneous causal inferences and implications. For instance, people at extreme ends of the weight continuum may have gained (or lost) weight due to health problems that affected their metabolism and mobility, and due to treatments for those and other problems (i.e., medications), rather than their weight gain “causing” their health (or mobility) problems.

    No matter what someone weighs, but especially at the highest weights, I cringe when weight is pointed to as being the problem, because that makes it likely that weight loss will be recommended and pursued “for health” rather than the treatment of any underlying condition(s), appropriate physical therapy/exercise, and good/adequate nutrition. Because people who lose weight will lose lean muscle tissue and possibly bone as well as fat, and those who are trying to lose weight (or who feel shamed about eating because of their size) may not eat well, and that, on top of the stress of fat hatred and associated stigma, can be counterproductive to well-being.

    Again, thanks for helping spread the word about Fat Kids. BTW, did you know Joy Nash has done the audiobook? I haven’t listened to it yet, but she has done a fantastic job on the novels she’s narrated/produced for Pearlsong Press.

    • January 14, 2015 1:55 pm

      Thanks for your comment, Peggy. I see what you’re saying about higher weights and I think to truly explain my view on this, I’m going to have to turn it into a full-blown post. So thanks for the inspo. 🙂

      And your chapter was most certainly epic. I would love to read the uncut version.

      Peace,
      Shannon

  12. January 17, 2015 6:57 pm

    I was at the library today, and there wasn’t a copy of Weinstein’s book available. However, I did put in a request for the library to add it to their collection. The librarian suggested that I allow a month to see if the request gets honored.

    They did have a copy of Body Respect available to reserve, so I’ve done that as well. I think I’ll go ahead and try to read both books before looking any further at the reviews.

  13. Julie permalink
    January 18, 2015 12:40 am

    Ms. Bacon and the purple heartbs are the reason I won’t get into haes. As much as I want and probably really need it, I just can’t associate myself with those kinds of people. That’s not how I want people to see ME. Haes already has a bad name as it is and it’s hard enough being discriminated and hated for just being fat without the added bs from people assuming you’re like that.

  14. pearlsong1728 permalink
    January 21, 2015 2:47 pm

    Julie, you say “Haes already has a bad name as it is and it’s hard enough being discriminated and hated for just being fat without the added bs from people assuming you’re like that.”

    I understand that HAES is scoffed at by fat-haters/shamers and those who are a part of the weight-loss industry (groups which, of course, overlap). But I wonder if you see HAES as being viewed negatively by people who embrace (or wish to embrace) fat/size acceptance? I know there has been infighting and complaints about lack of diversity among the most outspoken HAES proponents. Is that what you’re referring to, or do you see other problems?

    I ask because I am wondering if there is anything I could do (or write) to help those who may want to pursue a HAES approach, or think they may need it, but are put off by…..(fill in the blank). I ask this as a clinical psychologist/therapist (licensed health professional) as well as journalist & publisher. (Although my ID lists me as pearlsong1728, BTW, I’m Peggy Elam, who wrote the Fat Kids chapter Shannon mentions above.)

    Can you (or anyone else here) help me understand how HAES has a bad name? If you don’t have the time/energy or inclination to respond, though, no problem!

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