What Is the Fat Acceptance Movement?
The Beginning of Fat Acceptance
1967, Lew Louderback wrote an article called “More People Should Be Fat!” in the Saturday Evening Post. This was on op-ed in which he made four main points:
- "Thin fat people" suffer physically and emotionally from having dieted to below their natural body weight.
- Forced changes in weight are not only likely to be temporary, but also to cause physical and emotional damage.
- Dieting seems to unleash destructive emotional forces.
- Eating without dieting, allowed Louderback and his wife to relax, feel better while maintaining the same weight.
This article led to a meeting with another gentleman, William Fabrey, who together developed the first organization working for fat acceptance in the US, called "The National Association to Advance Fat Acceptance."
In the 1970s, spinoff fat acceptance groups were founded, including The Fat Underground, The London Fat Women's Group, and more. By the 1990's and early 2000's the fat acceptance movement continued to gain momentum, particularly with the creation of blogs and online communities based around fat acceptance. These groups and communities continue to gain steam today.
Health at Every Size
- Health at Every Size (HAES) is a model first developed within the book Health At Every Size: The Suprising Truth About Your Weight by Linda Bacon. It is one of the most prominent models within the fat acceptance movement.
- According to the author, "HAES acknowledges that well-being and healthy habits are more important than any number on the scale."
- The belief behind HAES is that "fat isn't the problem, dieting is the problem."
- This is a movement developed by psychologists to "support people in adopting health habits for the sake of health and well-being (rather than weight control)"
- HAES has to do with the understanding that eating nutritiously and exercising regularly are an important part of being healthy, but that weight gain or loss is not a direct cause of health or health problems.
- The HAES study is a study of women ages 30-45. They were divided into two groups (one group was taught traditional diet and exercise techniques, the other HAES group was taught to eat intuitively, to make healthy food choices, and to find physical activity that they enjoy rather than activity focused on weight loss. Two years later the HAES group had maintained a stable weight for the two year period, whereas the dieting group had lost weight at six months and gained it back within two years. The HAES group also lowered their total cholesterol and their systolic blood pressure and were able to maintain those reductions for the entire course of the study. On the other hand, the dieting group didn’t lower their total cholesterol at any point in the study, and weren’t able to maintain the healthful decrease in systolic blood pressure that they’d achieved at the six-month mark. Also, in terms of physical activity, the HAES group had nearly quadrupled the amount of time they spent in moderate, hard, or very hard physical activity. The dieters were exercising more than at the start at the 1 year mark, but they didn’t sustain their improved level to the two-year mark.
- The study found that a focus on health and behavior, rather than weight loss, led to better overall health outcomes.
Obesity and Health—The Controversy
One of the tenants of the fat acceptance movement is that individuals of all sizes can be healthy. In other words, size is not inherently connected with health.
Fat acceptance activists believe that the focus on dieting and the thin ideal are not well supported by science, and rather, may be a form of social control.
The science does appear to be unclear.
For instance, a research study conducted by Steven N. Blair, a professor at the Arnold School of Public Health at the University of South Carolina, suggests that some people can be overweight and healthy. In a 2007 study, he and colleagues found that "unfit" people over age 60 who were of normal weight had higher mortality rates during the 12-year study than people the same age with higher body-mass indexes (BMIs) who were fit (as measured by a treadmill test).
However, another study in Archives of Internal Medicine completed by researchers at the University of Tübingen, Germany found that the correlation between weight and health is not the same across the board. When comparing obese and non-obese patients' areteries and insulin resistance, they found that not all the obese patients had the same levels of health. Some had clogged arteries and were insulin-resistant, but about 25% of the obese people had clear arteries and no insulin resistance. These people looked no different than normal-weight participant in this way.
Yet another study by Rachel Wildman, PhD; Wylie-Rosett and other colleagues found elevated blood pressure, triglycerides, and blood glucose, among other problems in 24% of normal-weight people, 49% of the overweight, and 68% of the obese.
Studies from the Centers for Disease Control and Prevention continue to come to the conclusion that the lowest mortality rates are among people whose body mass index puts them in the “overweight” and “mildly obese” categories.
This study in 2013 found that weight loss was not linked to health.
There are many other studies looking at various sample sizes, locations, ages, races, genders, and so on, all with differing results. Currently, there seems to be no definitive answer as to the effects of weight and health, though more and more studies are showing that higher weights may not necessarily be less healthy. Many studies have shown correlation between weight and certain symptoms, but none have shown (and none have been replicated continuously to show) causation between weight and health long-term.
The Problem with BMI
- Much of the research on obesity and much of the judgment around weight is based on one's BMI
- BMI was developed by a mathematician as a formula to measure the general population's level of obesity to help the government allocate resources.
- BMI does not take bone size, muscle concentration, hydration or waist size into account.
- BMI creates categories of "overweight" "underweight" and so on, and assumes that height and weight solely place individuals into these categories. It is nonsensical.
- The Canadian Journal of Cardiology found that several lines of evidence suggest that weight loss or changes in BMI are not necessary to observe substantial health benefit from a healthy lifestyle
Diets Don't Work
- Studies continue to show that individuals who diet almost always gain back the weight, and often gain back more.
- Tracy Mann of UCLA has studied this phenomena for over 20 years. She found that dieting leads to a mental focus on finding food, hormonal changes leading to hunger and the slowing down of one's metabolism due to dieting. These factors cause diets to eventually fail and lead to consumption of higher calories in the long run.
- She also looked at 31 studies on weight loss to track the percentage of dieters who, over time, gained back more weight than they lost. She found that the average percentage of people who gained back more weight than they lost on diets was 41%, and she believes that number is low for a few reasons
- Diet companies and advertisers know that diets don't work, but they also profit off of individuals continuing to try to diet and failing repeatedly. The weight loss industry is a $61 billion dollar industry.
- Research supports the idea that weight loss and dieting do not actually lead to happiness.
- Those within the fat acceptance movement explain that people don't "choose" to be fat. It is not a lifestyle choice, but rather one's weight has to do with a multitude of factors and dieting is not the solution as it does not lead to long-term weight loss, it does not correlate with happiness and it does not directly correlate with better health outcomes.
Weight Discrimination and Implications
A 2012 Harris Interactive/HealthDay poll found that Fifty-two percent of people who fell into the "obese" or "morbidly obese" categories believe they have been discriminated against when applying for a job or promotion.
Further, obesity has been found to be a factor in employment discrimination.
This study found that higher patient BMI was associated with lower physician respect. Further research is needed to understand if lower physician respect for patients with higher BMI adversely affects the quality of care.
Yet another study found that individuals who do wish to lose weight are more likely to do so if they feel supported by their PCP (though this study does not look at the long-term ability of individuals to maintain weight loss.)
Clearly, weight bias and discrimination play a huge role in people's lives.
Final Words About the Fat Acceptance Movement
The fat acceptance movement is a movement that is constantly evolving
A few things are clear:
- Weight is not shown to be a direct cause of health problems, though some research shows that there may be some correlation between weight and health, direct causation has not been proven.
- Weight discrimination/bias/prejudice prevails in our society which maintains its focus on the thin ideal.
- Dieting does not lead to long-term weight loss. Rather, we continue to support the diet industry every time a diet fails and we try another one.
- Dieting and weight loss also do not lead to long-term happiness. Actually, dieting and weight loss tend to correlate with body dissatisfaction.
- BMI is not a reliable measure of weight, though it is still used by many people.
- Fat acceptance is a movement which supports the idea that all people, regardless of their size, have equal value.