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Size and Prejudice —

January 23, 2015

Weight LossFat PoliticsFat HealthFat ScienceExerciseMy Boring-Ass LifeFat NewsWeight Loss SurgeryDickweedDiet Talk

Serious Trigger Warning: Frank discussion of weight loss and weight loss surgery.

We’re coming up on our five-year anniversary here at Fierce, Freethinking Fatties and there’s one subject that I don’t think I’ve really ever talked about at length, oddly enough:  those people who are among the fattest of the fat.

I’m not sure why I haven’t really delved into it specifically, outside of ranting about headless fatties or citing statistics for so-called “morbid obesity.”

I was inspired to write about it after this comment from Peggy Elam (of which I’m including just an excerpt):

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.

These are great comments and it triggered a need to respond at length because it’s a subject that affects me quite directly. Part of it is that I have a BMI of 41, putting me at the low end of class III obesity. Some studies even differentiate further to focus on people with a BMI over 50 and my wife is in that category.

Headless fatties are typically in that >50 group. Some activists refer to them ironically as Deathfat, but whatever you call them, they are the fattest of the fat. They are also the group that the media turns to when it wants to shriek “OBESITY EPIDEMIC!” For example, courtesy of Huffington Post:

Obese

Oddly enough, the article, which includes photos from Hector Garcia’s life and death, touches on one of Peggy’s points perfectly:

After being ridiculed for being overweight as a kid, he began dieting in high school, but the weight kept coming back due to poor eating habits and, likely, a genetic predisposition to obesity … Around the year 2000, Garcia elected to have gastric bypass surgery, according to the Express-News. After the operation he lost close to 400 pounds, but he slowly gained all the weight back … In 2012, Garcia had surgery to replace both knees, which had been severely damaged by his weight. In order to undergo the procedure, he lost nearly 350 pounds. But complications of the surgeries led to disappointment and depression, a lack of exercise and return to seeking comfort in food, and by 2014, his weight was back to nearly 500 pounds.

If you’re at the extreme end of the weight spectrum, you are more likely than not to share a dieting history similar to Hector. When I hear stories like these, I can’t help but wonder what that person’s life would be like now if they hadn’t started dieting at all.

Of course, Huffington Post misses the forest for the trees on that one. Dieting and weight loss is de rigueur for fatties. It’s assumed to be our natural state. Little thought is given to the fact that dieting doesn’t work and the result is more often than not regaining the weight and then some.

The other way Huffington Post fails with this story is linking Hector’s story to obesity rates as it ramps up the health panic:

Sixty-nine percent of Americans over the age of 20 are overweight, and 35.1 percent are obese, according to the CDC. Obesity increases a person’s risk for numerous health conditions, including heart disease, stroke, Type 2 diabetes, sleep apnea and certain cancers. Roughly 3.4 million adults die each year around the world as a result of being overweight or obese.

The implication is that 35% of Americans are Hector’s size. I mean, this is the “toll of obesity” after all. As a result of conflating headless fatties with obesity, society has a skewed sense of what the body of an obese person looks like on average. For example, there’s this clueless chart from some panic-spewing dipshits:

BMI Chart

Compare those BMI categories to this series I did early in Fierce Fatties history having people guess the BMIs of those who submitted their photos to Kate Harding’s BMI Project. Compare the “overweight” category to this woman who has a BMI of 29:

The reality of high BMI looks different as well. Using myself as a proxy for BMI over 40 and this photo of Matieu Foley (who submitted his photo to this photographic height/weight chart) as a proxy for BMI over 50, this is a more accurate illustration of those two particular categories.

Comparison Fatties

So, when you hear about obesity rates, the vast majority of “obese” people have a BMI under 40. According to the most recent data, just 6.4% of the population has a BMI over 40. That means just 18% of “obese” people are my size or larger.

And I found one study that examined “extreme weight categories,” specifically people with BMIs over 50, which they term “super obesity,” illustrated below:

Fat Superman

Just one half of one percent of Americans are Superfats. Just one half of one percent are Matieu’s size or larger.

So when society freaks out about obesity, their reference category is an outlier subset, comprised of approximately 1.4% of obese people overall. To put all this in perspective, people with a BMI over 40 make up about the same percentage of the population as men over 6’2″, as I once examined in-depth with informative, animated GIFs of Pope Benedict and Saddam Hussein.

But just because Superfats are outliers doesn’t mean they deserve any different treatment from smaller fatties, let alone thin people. Body Acceptance is unequivocal. There are no buts in Body Acceptance. You either accept all bodies or you don’t. Period.

Body Acceptance is not about what you have to do in order to achieve acceptance. All bodies are accepted as worthy of respect as they are now, today, without exception.

“But Shannon, what about people whose bodies are unhealthy due to personal choices?”

Yes, them too. You know why? Because it’s not your fucking body.

Also, as I’ve written about extensively, if health were the actual reason that people hyperventilate over obesity, then we’d expect to see just as much vigilance over excessive drinking, right?

So, Body Acceptance is non-negotiable. It’s universally available or it’s crap.

But Body Acceptance is not Health at Every Size® (HAES). BA and HAES are lines moving in the same direction, but they are not the same lines. The goals of BA are different than, but complementary to, the goals of HAES. Most importantly, BA makes HAES possible, while HAES is not necessary for BA.

When it comes to HAES, whether or not you pursue improved self-care or not is between you and whoever you want to be involved in that decision. This includes whether or not you want to lose weight.

I’ve known several Superfat people larger than Matieu who have struggled with their quality of life and feel a sense of desperation about their situation. I know there are some in the Fat Acceptance movement who automatically shun anyone who gets weight loss surgery, but I feel like this violates the principles bodily autonomy. Who am I to judge the choices of other people? Now, if that person is talking about weight loss all the time and you have to distance yourself as an act of self-care, that’s understandable. But for an activist community to treat everyone who loses weight as a pariah and an outcast is too extreme for me, regardless of how I personally feel about WLS. Bodily autonomy is absolute.

Are all Superfat people physically suffering, desperate, or sick? No. But for those people who are, we can’t simply tell them that weight is irrelevant. In some cases, weight is very relevant. For example, if a person develops insulin resistance (IR), weight gain can be a symptom of metabolic disorder. In one of my earliest interviews with Dr. Linda Bacon, she explained how IR and body weight are cyclical — IR affects weight and weight affects IR. To complicate things even further, weight cycling almost certainly contributes to IR (for an explanation of how and why, I highly recommend this open-source paper on the “repeated overshoot theory”).

As a Superfat person with IR, if you want to improve your health, then there are steps you can take without making weight loss the goal. Treating IR may or may not result in weight loss, but when people change their diets and increase exercise, the average weight loss seems to be 5-10% of starting weight. That’s it. A few outliers may lose more or less, but the average lose 5-10% as a result of adopting healthy behaviors and that’s enough to mitigate the risks associated with obesity, according to experts outside of the HAES realm. And yes, that includes a 500 pound person who “only” manages to lose 50 pounds.

Fat, or adipose tissue, is not a benign, inert substance, as biologists believed for years. It’s an active metabolic and endocrine organ that produces numerous hormones that can alter a body’s function, a fact that has only become truly understood in the past 20 years.

One part of what we’re learning is that the restriction/disinhibition cycle behind yo-yo dieting upsets adipose function. The other part is that having more fat does affect metabolic function in some people. Both facts seem to be the unfortunate reality.

If we truly want to understand health from an objective position, we have to examine all of the physical realities that come with having a larger body. And for that portion of the population who are at the extreme ends of the weight spectrum, we need to be willing to consider that individual circumstances vary and that self-care sometimes requires exposure to uncomfortable truths.

Fortunately, we all have the innate ability to examine our own reality and understand what we can and cannot do, what we do and do not want, what we are and are not feeling. And for HAES to be effective, we must respect that right completely.

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12 Comments leave one →
  1. vesta44 permalink
    January 23, 2015 2:41 pm

    I’m one of those “super morbidly obese” outliers, with a BMI of 62 (and I still haven’t gotten my cape). I’ve given up trying to figure out whether my weight “caused” my mobility issues or whether the repeated dieting and failed WLS caused my weight issues which then aggravated my mobility issues. At this point in my life, it doesn’t really matter – doctors don’t give a shit why I have the issues I do, all they care about is continuing to try to make me thinner and therefore “curing” all my ills. I’m 61 years old, and I’ve weighed 350+ lbs for 39 of those years. According to doctors, I should have died 34 years ago – and I’d be willing to bet that every one of them that predicted I’d be dead within 5 years if I didn’t lose massive amounts of weight would be surprised and pissed to learn that I’m not dead yet. And I have no intention of dying any time soon (knock on wood – there’s always that unexpected chance accident that can happen to anyone, no matter their age or size).

    • Jennifer Hansen permalink
      January 25, 2015 2:15 am

      BMI 40-something, last time I cared to check, and they’ve been predicting my death for 20+ years now!

      • Dizzyd permalink
        January 31, 2015 5:06 pm

        Jennifer, lol! Probably thinking to themselves, “darn it, why isn’t she dead already?”

  2. Dizzyd permalink
    January 23, 2015 5:55 pm

    I may be jumping the gun, so to speak, but if by “uncomfortable truths” you mean “may need WLS”, then I say “Forget it!” I have to admit that this was a little bit triggering for me, because every time I hear that Death fatties like I obviously am at 40-plus BMI are at increased risk of dying of anything and everything unless I do as the doctor tells me and “lose all that excess weight”, that’s what I start thinking of. I know that wasn’t your point, I’m just saying that that’s what goes through my mind.

    • January 24, 2015 9:43 pm

      Hi Dizzy,
      The uncomfortable truth I was referring to was that some Superfat people do have health problems related to their weight. I want to discourage people from blind denialism, where we insist that fat is never a factor in health. It can be, but we need to take it on an individual basis. A rational medical community would treat weight as just another risk factor, no more or less relevant than blood pressure or blood sugar. This is what Gerald Reaven advocated and I think it’s lightyears away from the weight-panic the medical community relies on now.

      Peace,
      Shannon

  3. Ivan permalink
    January 24, 2015 12:31 pm

    Just the thought of a rational discussion of what my healthcare looks like, the challenges i face as a deathfatz create such anxiety for me. I am a smart guy and I believe there is merit is discussing the issues of being 450lbs, but the shitstorm that is internet hatred has driven me underground making this my first public comment in several years.

    I am the boogeyman. I think that a reason for the little discussion in this and other forums about what it means to have resigned myself to live at 450ish pounds is because I am the worst nightmare. I am the horror show that others pointed to in my past to warn me of what I would become if I didn’t get the food straight.

    A dignified, discussion of this would bring forth the lowest of the low of what the internet has to offer and I can’t handle that kind of hatred in my life.

    • January 24, 2015 9:46 pm

      Ivan, you’re one of the people I had in mind when I wrote this piece. It’s true that bringing up this topic invites trolls, but you know that we keep this space safe. I would never, ever let a comment get through the filters that would serve as an attack on you or anyone else. I think we need to be discussing Superfat physical and mental health because even though they make up a small percentage of the population, their suffering is no less important.

      Ivan, just know that when things get too dark, you’ve always got a friend in me. You know where to reach me.

      Peace,
      Shannon

      • nycivan permalink
        January 25, 2015 2:52 am

        FFF is a safe place… I think a lot of it is internalized drama in my own head beacause as you said there is some cause and effect to my size and my ailments. I think I may be commenting more often, thx shannon

  4. January 24, 2015 9:04 pm

    My BMI is almost 45 and this is what I look like: http://photos-f.ak.instagram.com/hphotos-ak-xaf1/t51.2885-15/10864920_731001170315749_1901537139_n.jpg
    I’ve gotta say, looking at that bright orange guy representing BMIs of 40.0-49.9 feels just like looking in a mirror. It’s uncanny!
    And as a fat person with chronic illnesses, I definitely think a bit about the assumptions people make about the relationship between that and weight.People often treat sick or disabled people who are fat as though they must be sick or disabled because they are fat. There are no other possibilities.

  5. January 25, 2015 9:48 am

    I’m sure it’s no accident that HuffPo avoids giving a true impression of what range of bodies exist as officially “obese.” A whole lot of their space seems to be all about shameless click-baiting and fear mongering. (While gunning for that sweet, sweet diet-drug-fitness ad revenue, perhaps? I don’t remember if they have ads. My ad-blocker is switched on and I’m not shutting it off.) With a gloss of unevenly applied niceness to distinguish them from the “Fair & Balanced” crowd.

    It’s telling that looking over there today, one of their side-headlines mentions that “Most 10-year-old girls have dieted.” It makes you wonder whether even the liberals who pride themselves on their intelligence and compassion will ever put two and two together. (Not that I’m letting my fellow/sister “fringy” Leftists off the hook. Some of them are as bad, or worse, than what you’ll find tooling around HuffPo.)

  6. BarlowGirl permalink
    February 4, 2015 3:56 pm

    You know what’s interesting, and by interesting I mean “more proof bmi is jack” is that, mine is somewhere around 45 depending on calculator, high enough to be “morbidly obese” by most of them. I only weight 250 pounds, though, but that thing where I’m short makes things weird. 250 pouns on five foot two (and a half) does look quite different than 250 on a taller frame.

    I got lost a bit in that comment, lol, but I don’t think my kind of number is the one people think of with these things and it just goes towards the view of this stuff, I think.

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