[Editor’s note: The following top 10 is a rebuttal to the “Top 10 Reasons Why the Fat Acceptance Movement Should Be Ashamed of Itself.” I contacted the author after reading an article on his blog, and he was kind enough to write the following, exhaustive post on how the author of ListLand.com’s prior article got the fat acceptance movement wrong. Enjoy.]

As I read through the original list, I was struck by how wrong the author got everything. I mean, from the opening paragraph to the concluding argument, the author clearly has no idea what she’s talking about. And after five years of sparring with hundreds of people over things I’ve written as the Chief Fatty at Fierce, Freethinking Fatties, I can honestly say that most critics have no idea what they’re talking about when it comes to the Fat Acceptance movement (which the author inexplicably abbreviates as FAM, even though most people simply call it FA) or Health at Every SizeR (HAES).

For example, the piece begins by claiming “The fat acceptance movement also known as ‘health at every size’ subscribe to the following pledge.” First off, I love how it sounds like fat people are recruited to join a cult and are made to stand in a solemn circle around the McDonald’s fryolator as they swear their a blood oath to the Obese Brotherhood.

There’s no pledge to FA and, furthermore, FA is completely separate from Health at Every SizeR (HAES). You don’t have to practice HAES to be part of FA.

FA is a form of Body Acceptance, the idea that self-loathing is linked to self-harm as people do not take care of something that they don’t love. If you’re ashamed of what you look like and are desperate to change it, you may resort to increasingly desperate actions in the pursuit of an ideal.

For many fat people (particularly fat women), those increasingly desperate actions include repeated attempts at dangerous weight loss practices. I will go into greater detail later, but in a nutshell, severe caloric restriction or over-exercising results in unsustainable weight loss, which typically leads to weight regain, while more modest lifestyle approaches don’t result in the “significant” weight loss that people expect. Disappointment with modest losses results in abandonment of healthy lifestyle practices and the cycle of loss and gain continues.

I understand why some people have a problem with both FA and HAES, but if they want a movement to “take a long look in the mirror and feel serious, wallow-inducing shame,” then at least get your facts straight. For starters, here are the ten big “dangerous, uniformed and/or violently misrepresentative ideas” that the author got completely wrong, starting at the end of her list and working my way backwar

10. Acceptance is not the same as ignorance.

As stated above, FA and HAES are separate entities. They’re often seen as identical by outsiders because many FA bloggers also write about HAES. But FA isn’t about health, it’s about self-acceptance. That’s it. So let’s assume the author is right and anyone with a BMI over 30 is unhealthy and that choosing to maintain a BMI over 30 is a deliberate choice to be unhealthy. So what?

How many articles has this author written about the dangers of drinking or smoking or doing drugs or driving like a dumbass or having unprotected sex with anonymous partners? What is it about the unhealthy “choice” of being fat that offends her so much?

For example, when’s the last time you read Listland’s “Top 10 Reasons Why Don Draper Is a Terrible Role Model.” If you Google the show, you get skeezy dudebro odes and Christian Science Monitor articles on Draper’s moral ambiguity.

And yet, each year over 5,000 people under age 21 die each year from alcohol-related and one in ten deaths among adults aged 20-64 is due to excessive drinking. Where’s the urgent outcry from angry bloggers over the glorification of drunken debauchery?

The typical answer is “Well, smokers and drinkers know they aren’t healthy. There is no Smoker’s Acceptance.” My first response would be that’s probably because if you shame smokers or drinkers, you’re probably going to be accused of being an agent for the Nanny State. But more importantly, it doesn’t matter if you accept smoking and drinking as healthy or not, just as it doesn’t matter whether you accept being fat as healthy or not. We accept the fact that some people smoke and some people drink and as long as they aren’t infringing on our health or safety, then we typically shrug our shoulders and say “More power to ya.”

The author takes her concern trolling to the next level by claiming that America’s waistline is out of control and that the tidal wave of fatness will consume us all. “The U.S. is fast approaching a future in which most individuals will be obese. Not fat. Not chubby. Not pleasantly plump. Obese.”

Apparently, the Centers for Disease Control and Prevention (CDC) have changed its BMI categories, according to the author. Here’s a quick rundown:

Pleasantly Plump : 25-30 kg/m 2

: 25-30 kg/m Chubby : 30-40 kg/m 2

: 30-40 kg/m Fat : 40-50 kg/m 2

: 40-50 kg/m Obese: 50-9 gazillion kg/m2

If you look at the data, you’ll find that the same epidemiologist from the CDC who pointed out obesity rates were rising in the 1980s has been telling people since 2012 that obesity rates have leveled off (PDF). The greatest rise in obesity rates occurred between 1980 and 1999 (PDF). After that, obesity rose a bit in men, but not women.

Something changed between 1980 and 1999, but the idea that it’s because there’s this one particular group who has never heard the idea that fat people are unhealthy is not the reason.

Repeatedly doing the same thing and expecting different results is how some people define insanity.

Fat person says, “I’ve tried everything and I just can’t lose weight.”

“Did you try X?”

“Yes. Yes. I tried X.”

“Yeah, but did you do Y?”

“Yes, I did Y.”

“Because sometimes people do X, but they don’t do Y.”

Some treat fatties like a puzzle that needs to be solved. These Benevolent Advisers either adopted behavior X themselves or know people who adopted behavior X and swear that if you just do X, then you’ll be thin too.

The implicit assumption is that the Benevolent Adviser will be the one to <sarcasm>finally, FINALLY impart that crucial bit of wisdom that you’ve never, EVER heard or read about in your ENTIRE LIFE.</sarcasm>

Basically, fat people are seen as incapable of being in charge of their own bodies, so they require a Benevolent Adviser to help them find the path to a “better” body.

But what do the experts say? You know, the physicians who work primarily with fat patients? For example, there’s Dr. Arya Sharma, Health Services Chair in Obesity Research and Management at the University of Alberta. He’s got a great blog, he’s a bariatric physician and he’s widely regarded as an expert on the subject.

In an interview I did with him back in 2009, Dr. Sharma warned against judging a book by the size of its ass:

Don’t blame people for their weight because you can’t look at somebody and, based on their size, immediately jump to conclusions about their lifestyle. I’ve got a lot of patients in my clinic who are large, who are obese, who know more about nutrition, more about healthy living, and are actually practicing those principles than some of my thinner patients who come and have other problems.

For many fat people, they’ve spent years attempting X and Y, as well as everything from A to ?. The problem isn’t lack of knowledge, it’s lack of sustainability. As I alluded to before, Biggest Loser-esque results are statistically rare because the lifestyle required is largely unsustainable, while a healthy lifestyle that is sustainable rarely results in Biggest Loser-esque results.

Note: For those who are currently experiencing a throbbing vein because you can’t wait to educate me in the comments about how wrong that is, don’t worry, I will provide more than adequate substantiation to back up my claims.

Telling fat people that they wouldn’t be fat if they just had “good habits” is like telling a person with a cold that they would feel better if they just took some medicine. Thanks, C. Everett Koop.

Self-esteem is not an Olympic medal. “I’m all for people having self-esteem, but…

This is how the sensitive fat hater starts this tired, old argument. As it was written in the original top 10:

Again, does this go for smokers and drinkers and unsafe sexers? I mean, I didn’t realize that my worth as a human being came with a sign reading “You must be this healthy to love yourself.”

The idea behind the earned esteem argument is that fat people should not love themselves until they’ve “done something,” which inevitably means weight loss. Except, that’s complete crap.

It doesn’t matter if you’re training to do a stair climb or a marathon, even “Good Fatties” are targets for public ridicule. Why? Because their hatred has nothing to do with health. Fat haters have a visceral disgust that they have to justify as rational because otherwise mocking people for the way they look would make them just plain ol’ dickweeds, right?

Right.

If you can’t trust yourself, who can you trust?

The gist of this flawed argument is that fat people are fat because in the words of the author, they have “gone off the tracks and is a state of utter disrepair.” Summoning all the depths of her scientific knowledge, she explains that a fat person’s “internal sensors have short-circuited.”

Therefore, a fat person can no more trust themselves to know what’s right for their bodies than an anorexic or an alcoholic or a heroin addict.

I am 5’7″, 265 pounds, giving me a BMI of 41.5, making me class III, “morbidly obese.” The idea that my weight alone determines whether or not I’m capable of taking care of my own body is ridiculous.

What is even more ridiculous is this: “Obtaining advice from a trained medical professional and following that advice is paramount.”

Why? Because the author makes it sound like fat people have never even heard of doctors and that HAES is somehow anti-doctor.

Recently, I had the honor of interviewing Dr. George Blackburn, Professor of Surgery and Nutrition and Associate Director of the Division of Nutrition for the Harvard Medical School. His credentials are unimpeachable. We discussed the original insurance tables (the foundation for the modern body mass index (BMI) metric) and the fact that insurance companies found their most profitable customers weighed 120% of the ideal body weight. But making that statistical ideal the goal weight for all people has proven incredibly flawed.

Obviously we found nobody could do that except by surgical interventions, which there are huge side effects. But people thought that and believed that and wanted that – they didn’t care what the high risk was. They wanted to get within 120% of ideal body weight. That’s just too much harm, too much expense and it’s just not ethical. Then the surgeons got a safe operation and said, “Wow, look we can get a 20% weight loss and those medical people can only get a 5% weight loss. Go our way.” But that’s only for 200,000 individuals, who are severely obese, class 3 obesity… There is no public policy that says get a 20% weight loss. The public policy is to get 5-10% weight loss. [emphasis mine]

To put Dr. Blackburn’s words in perspective, I am at the low end of class 3 obesity. This is what being “severely obese” looks like when you’re being attacked by a rat.

Here’s what “severely obese” looks like when it finishes a 40-flight stair climb.

As a “severely obese” person, I am a candidate for weight loss surgery. I’m not immobile, I’m not suffering from metabolic disorders, I’m not incapable of pursuing a healthy lifestyle. And most people who are “severely obese” are like me, having a BMI between 40 and 50. Just one half of one percent of Americans have a BMI over 50.

But according to Dr. Blackburn, the public health policy is that even a person with a BMI of 50 or more should aim for a goal of losing just 5-10% of starting weight. Period. I asked Dr. Blackburn if he would recommend losing just 10% to the subjects of HBO’s documentary Weight of the Nation:

“Absolutely,” he said. “And any doctor who measured the blood pressure, the triglycerides, the lipid profile, the blood sugars, the inflammatory markers, all would find those improved, just like you say. When you added resistance exercise, you further enhance your health markers, and exactly the same thing would happen with a 50-pound weight loss in a 500-pound person.”

So why? Why would this renowned Harvard nutritionist be suggesting that a 450-pound person is healthy? Why is such modest weight loss enough? Oddly enough, the original author got it right with the short-circuiting internal sensors:

You can see how important the hunger control is so you don’t rebound and get binge eating. So you don’t want to follow a healthy diet which you end up hungry because you won’t be able to do it. That’s why we’re so restricted. that’s why all our efforts are in preventing the weight gain because losing more than 5-10% of weight just upsets hunger hormones in the brain and makes it very difficult to be compliant.

Being fat isn’t what makes fat people act like heroin addicts; that’s caused by trying to lose more than 10% of your starting weight (aka the thing Benevolent Advisers tell every fat person they must do).

So if anybody deserves our mistrust, perhaps it’s the “experts” who say that losing as much weight as possible should be the goal of every fat person.

What the world needs now is acceptance, sweet acceptance.

Okay, in the original list, numbers 5 and 1 are the exact same thing. I could easily play devil’s advocate and come up with a hundred asinine reasons why “FAM” is terrible and never repeat myself once. How different is 5 from 1?

Number 5: accepting yourself is as self-deceptive as it is self-destructive… Self-awareness is crucial when attempting to fix a problem or cure a disease.

Number 1: Because Accepting an Obese Body as Normal or Healthy is Purposefully Harmful… Obesity leads to cancer, heart disease and kidney disease, which are the three leading causes of death that are in turn all caused by obesity.

Okay, we get it: fat people can’t accept themselves because their fatness is a disease that must be cured. But let’s take a look at the actual evidence regarding the three diseases the author circuitously refers to as “caused by obesity.”

For a science-driven argument, the author sure likes to make declarations that are much less clear in the research. For instance, the Medical Clinics of North America published a special issue on diabetic chronic kidney disease (CKD) in 2013 that included this article on obesity, diabetes and CKD:

Obesity is a well recognized risk factor for both type 2 diabetes and hypertension … however, this relationship was no longer significant after adjustment for known cardiovascular disease risk factors, including diabetes and hypertension. Numerous other studies have also demonstrated that the association between obesity and CKD is mediated though risk factors including diabetes, hypertension and other elements of the metabolic syndrome. [emphasis mine]

When people talk about the “disease of obesity,” what they are actually talking about is insulin resistance (IR) and the metabolic syndrome that results. Yes, IR is more common in fat people because IR causes weight gain and weight gain exacerbates IR. But not all fat people have IR and not all thin people are immune.

Untreated, IR can lead to cancer, cardiovascular disease, CKD, type 2 diabetes, and more. The treatment for IR isn’t necessarily weight loss, but an healthy, balanced diet and increased physical fitness. Asthis review of exercise from the American Heart Association summarized:

Despite relatively modest weight reductions associated with structured programs of physical activity, findings from large epidemiological studies support the concept that a reduced risk of cardiovascular disease and all-cause mortality occurs among more active individuals regardless of weight loss… Compared with other risk factors (total cholesterol, hypertension, and smoking), having a low fitness level carried similarly heightened risks in each weight category for both cardiovascular and all-cause mortality. [emphasis mine]

In other words, skinny people who are sedentary have the same risk for heart disease and death as fat people who are sedentary. Does that mean we demand that all sedentary people stop accepting themselves until they change their behaviors? Nope. Because that’s a dick move.

Fat is not a disease.

Once again, the science-minded author declares unequivocally:

“Avoiding” obesity is like “avoiding” economic insecurity. The assumption is that everybody’s on a level playing field and can simply “bootstrap” themselves into success. Except we know that both claims are flawed.

Like the Horatio Alger myth of self-determination, the idea of malleable bodies is rooted in hope, not fact. In fact, like wealth, the vast majority of influence over one’s weight is passed down from parent to child.

I hear you scoffing at the genetics claim, largely because you don’t understand how genetics works (we’ll just roll that one into number 5). For a refresher, check out this article from Oxford’s Human Molecular Genetics journal. There have always been fat people. What’s new is that power and privilege are no longer insurmountable barriers to reliable, sustainable food supplies.

Food security is just as likely a culprit of increased obesity rates as the quality of food that exists. I mean, have you ever watched Supersizers Go?

One of the many indulgent meals enjoyed by the Medieval aristocracy.

Those who could afford it were eating some of the most decadent and indulgent foods in history. Some got fat, while others didn’t.

Genetic heritability for high weight is between 50-90%. If you have access to a sustainable food supply and your family is on the heavy side, you can expect to be on the heavy side yourself.

And now, we’re learning that there may be additional factors contributing to increased obesity rates like unhealthy gut flora and exposure to endocrine disruptors. Oh, and don’t forget that weight cycling causes weight gain, and that it coincidentally became our national pastime around the same time that weights began to rise.

If you ask a fat woman how many times she’s lost weight, she can most likely tick off the 25, 50, 100 pounds she repeatedly lost, then gained back the same, if not more.

Rather than treating weight as a disease, it would be healthier for our culture to treat weight as a state of being. Treating fat children as diseased has resulted in countless lifetimes spent pursuing a goal which the vast majority of people do not succeed in maintaining.

Finally, as far as what my doctor will or will not say, I’ll turn to over to Dr. Yoni Freedhoff, who runs the Weighty Matters blog and wrote the following in his recent book The Diet Fix:

From a medical perspective, there is perhaps no other modifiable determinant of health that has a greater impact on your health than exercise. Being fit and eating a healthful diet, regardless of your weight, is an important goal, with exercise and healthy eating virtually erasing a large percentage of the statistical risks of the weight itself. What that means is that yes, absolutely, a person can be both fat and fit. [you bet that emphasis is mine

Saying the same thing over and over doesn’t make it true.



“The FAM believes that you can be healthy at any size. This is dangerous, reckless, or deliberately intended to deceive.”

Here we go again: FAM are liars who trick fat people into not believing that being fat causes disease. It’s the same argument as 5 and 1.

As I previously said, the “FAM” is not the same as HAES. FA does not declare fat healthy or not. FA simply says that you shouldn’t be a douchebag to people just because they’re fat. There’s no intent to deceive here: whether you’re a healthy fat person or any unhealthy fat person, you deserve to be treated with dignity and respect.

Once again, the author declares in no uncertain terms that there’s no debate about whether you can be fat and fit. The argument she believes will “stop FAM in its tracks” is the “fact” that “obesity causes heart disease, which is the leading cause of death in the United States and the world.”

One of my favorite interviews of all time was with the widely-respected expert on exercise, Dr. Steven Blair. According to Dr. Blair, half of all obese people are fit by cardiorespiratory standards.

Bottom line, what we’ve found, is that low cardio-respiratory fitness, those who are unfit, is really one of the strongest predictors of morbidity and mortality of anything we’ve measured in this data set. For example, over 50,000 men and women followed for on average more than 10 years and about 4,000 of them died; 16 to 17% of those deaths can be said to be caused by low fitness; 2 or 3% of the deaths were caused by obesity; I think that 4 or 5 or 6% to diabetes. The only thing that was even close to low fitness in terms of the number of deaths it caused in the population was hypertension in men.

In fact, Dr. Blair’s work showed that unfit “normal-weight” people have twice the death rate of moderately fit obese people. As explained previously, lifestyle is the primary controllable factor in someone’s health, not their weight.

The author of this list insists that science must take precedence over the “dangerously ignorant point of view or a purposeful lie perpetuated by disingenuous charlatans posing as prophets.” And yet, the closest she’s gotten to actual science is in making bold declarations of truth over and over and over without having any clue what the science really says.

This is nothing but the George W. Bush version of science.

Fat people don’t corner the market on laziness.

“To accept an obese body as normal is to accept the behaviors that lead to such a state.”

The author seems to think that when you see a fat person you are seeing the manifestation of unhealthy lifestyle choices. Therefore, when you see a thin person you are automatically seeing the manifestation of healthy lifestyle choices. I don’t think I need to go into too much depth here. Suffice it to say, we all know lazy, gluttonous thin people who drink too much or drive like morons or don’t get enough sleep.

So when you see a fat person, all you are seeing is a person who is bigger than average. You cannot diagnose a person on sight. And quite frankly, it’s magical thinking to believe that you can. Furthermore, it’s narcissistic thinking to believe that you should.

The world is fat.

I can only imagine the Fox-addled mind that came up with the attempted shame-inducing claim that being fat is unpatriotic. The author flat out stats that “FAM is unAmerican” and uses the bootstraps analogy to make her point.

What are we supposed to say, “It’s American as locally-sourced, gluten-free apple pie?” But let’s set aside the absurdity of the argument and focus on what “American” means. First and foremost, it means being born in America. Secondly, as President Calvin Coolidge said in 1925, “the chief business of the American people is business.”

Part of the “American dream” is the idea that any Joe Schmoe can wake up one day with a brilliant idea, build a business around it and go from pauper to corporate prince overnight. We largely consider entrepreneurship the hallmark of American ideals.

So what has happened in American business culture that has contributed to rising obesity rates. For one, the average American family transitioned from the single-income household of the 1950s to the two-income household of the 1980s and beyond.

As a result of increasingly competitive school districts, the housing market became increasingly competitive as parents sought to give their kids the edge in education. As Senator Elizabeth Warren wrote in her brilliant book, The Two-Income Trap, this created a race to the mortgage lenders and a housing bubble that pushed millions of families into competing for greater and greater debt loads. At the same time, wages began to stagnate even as productivity rose.

So families have less time and less money, but families are expected to perform at the same level of wholesomeness and the Cleavers.

At the same time these socioeconomic trends were shifting, the physically intense sectors of Manufacturing and Agriculture continued their steady declines, while the relatively sedentary Service sector rose to dominance.

That Service sector pays less, provides fewer benefits and expects more of their employees.

What’s a parent to do? Enter the American entrepreneur. The 1980s saw the rise of fast food and convenience groceries that attempted to fill the void that these new socioeconomic realities created. Although the post-War 1950s were the Golden Age of catering to harried housewives, the 80s and 90s gave time-crunched families the products they needed to keep their families afloat.

Not much has changed recently, except that the convenience and fast food markets have diverged for upper and lower class consumers. If you’re wealthy, you may still rely on convenience foods, but you probably have access to less-processed products that don’t rely on high fructose corn syrup to stave off freezer burn. And if you’re poor… well, then you’re just SOL if you can’t satisfy your family on the sacks of rice and beans that Benevolent Advisers recommend.

The fact is that the definition of “American” has changed, and American businesses have revoked the social contract that made it possible for one parent to work while the other stayed home and maintained the home. This includes the preparation of the kind of whole, natural meals that we believe fat people are neglecting out of cluelessness or laziness or whatever moral shortcoming we wish to assign them.

But the thing is, being fat is not a uniquely American trait. In fact, according to data from the Central Intelligence Agency, the United States is tied for 18th place as the fattest country in the world.

So in that regard the author is right: being fat is unAmerican. It’s simply human.

Science is central to HAES.

Science has little to do with FA, but it has everything to do with HAES. Above, I have outlined the science behind HAES, including interviews with obesity experts who substantiate the HAES claim that weight loss in and of itself is not the “cure” that we’re told is common sense.

In fact, the science is so clear on this, that virtually every study on long-term weight loss will inevitably declare success by defining success as “clinically significant weight loss.” What is clinically significant weight loss? Just 5-10% of your starting weight.

Referring back to my photos, you have no idea whether I’ve just lost 30 pounds or not, and if I had, then obesity researchers would define me as a “successful.” Meanwhile, the author of the original list would still be screaming at me about how I hate science and America.

As the author demonstrated, people who hate FA and HAES can barely distinguish the two movements apart and are clueless as to why anyone would think it’s okay to be fat.

The answer is simple: behaviors and body sizes do not determine the worthiness of a person. Whether you’re healthy or sick, thin or fat, American or not, you are a part of humanity who gets to love yourself the way you are now, today, no questions asked.

If you want to be healthy, there are steps you can take to improve your odds, but those behaviors won’t likely result in you achieving your “perfect” body. And if you want to encourage people to improve their health, then research shows that literally the worst thing you can do is insist that they live in a world of self-loathing, depression and loneliness.

Of course, understanding the science is not nearly as important as screaming “common sense” maxims and attempting to mass shame the people who disgust you.

To attempt anything else would be shameless.