Today I got a comment from a nurse asking some often asked questions about health and fat, specifically for the “super fat” (of which I am one) You can read the full comment here (it may be triggering, though I feel it was asked very respectfully) but the basic question was -and I’m paraphrasing – what about when very fat people have health problems, surely then obesity is considered a medical problem?

The first thing I want to make clear is that, as Ann mentioned in her comment, there are simply no proven ways to make fat bodies thin. In fact statistically the far and away most common outcome of intentional weight loss attempts is weight gain, so even if one thinks that being fat is a medical problem (and I don’t agree that it is for the reasons that follow) then prescribing dieting is no better than prescribing a cancer treatment that cures cancer a tiny percentage of the time, but the vast majority of time makes the cancer worse.

But I think the real solution is to take weight out of the health discussion and treat the medical issues as the patient wishes (which is to say that people are allowed to make choices for the prioritization of their health and the path they choose to get there including medical care). If a thin person is dealing with immobility, we treat the immobility. If a fat person is dealing with immobility, we “treat” the body size. I think that giving body size interventions for health problems is a major part of the problem. If a person is fat and has mobility issues, then we should treat the mobility issues with options including physical therapy, massage, surgery, mobility aids etc. If a fat person has diabetes, then we should give that person interventions that are shown to control diabetes (weight loss is not one of them.)

Studies show that, no matter what size someone is healthy habits are still the best way to increase our odds of health (though of course nobody is obligated to do so), and working on fitness goals like strength, stamina and flexibility, at whatever level the person in interested in doing, is still the best way to improve strength, stamina and flexibility.

I think that the medical world would be helped greatly by treating a fat person with a medical issue the same way they treat a thin person with the same issue. For example, when I was thinner and had knee pain I was given tons of options – physical therapy, medical massage, surgery, crutches etc. When I was fat and had knee problems I was told to lose weight. Because of my previous experience with a knee issue I was able to use the same things that had worked when I was thin to solve the issue but had I increased my exercise as the doctor suggested in a bid to lose weight, I would have been almost certain to exacerbated the injury.

In order to give fat people appropriate medical care, there are three main things that the medical establishment needs to do:

First, they must stop confusing body size with a physical or mental health diagnosis. A doctor cannot tell from someone’s size what their health status is, if they have an eating disorder, or anything other than the size of the fat person’s body, and that doctor’s preconceived notions about people that size. I believe that healthcare professionals need to be specifically aware of, and manage, their preconceived notions and prejudices.

Second, they must let go of the fantasy of weight loss as a miracle cure all, or as evidence-based medicine at all. Healthcare practitioners need to stop prescribing weight loss for everything (I’ve been prescribed weight loss for a broken toe, a separated shoulder,and strep throat.) In fact, they need to stop prescribing weight loss at all.

Once we give up the weight loss fantasy, we can start giving actual evidence-based health interventions to fat people. Once we take weight loss off the table, it can open our eyes to other treatment options.

Finally, we must work to end shame and stigma against fat people by the medical establishment and beyond. If fat people are ashamed of their bodies or shamed for their bodies or health conditions then they are less likely to take care of themselves and more likely to avoid the doctor, and avoid things that can help them (like mobility aids) and that’s definitely detrimental to fat people’s health.

If we take weight out of the health discussion we give ourselves the opportunity to actually, finally, have a health discussion and that’s better for the health of everyone of every size.

If you’re looking for the evidence I discussed above, just click here and scroll down.

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