Dear Fat-Positive Movement:

Here is a fat-positive manifesto I could live with.

We need to make major changes in how our society views weight, fatness, and fat people. Our society has an excessively narrow definition of what constitutes an acceptable body type, and it's a definition that is unattainable for the overwhelming majority of people. People can be healthy, happy, and attractive at a variety of sizes; the standard medical definition of a healthy weight range is almost certainly too narrow, and some evidence suggests that it may be too low. Furthermore, many popular weight loss programs are grossly unhealthy, both physically and psychologically, and are aimed, not at maintaining good health, but at an almost certainly fruitless attempt to attain the cultural ideal of beauty. And many people who try to lose weight have no earthly medical reason for doing so.



We demand that people be treated with respect and dignity regardless of their size. We demand an end to job discrimination based on size. We oppose the moral outrage that is commonly aimed at fat people, and the persistent media representations of fat people as objects of disgust and ridicule. And we demand an end to medical discrimination based on size: we expect doctors to treat fat people with respect; to discuss weight loss with fat people as one option among many instead of the one course of action that must be pursued before any other; and to treat non- weight- related conditions equivalently for all patients, without regard to size.

Weight loss is both very difficult and very uncommon, especially in the long term. And we don't yet know why it's so difficult, or why a few people are able to do it while most people are not. We therefore think it's completely valid for a fat person to decide that weight loss isn't where they want to put their time and energy. Many of the health risks associated with being fat diminish significantly when people eat a healthy diet and get regular exercise -- even if they don't lose weight. We therefore encourage fat people to be as healthy as they can be: to eat healthy diets and get regular vigorous exercise, even if they don't lose weight doing so. And we encourage people who do choose to lose weight to do so in a healthy, sustainable way.



We understand that there are health risks associated with being fat. There are health risks associated with many things -- things we have control over, such as playing rugby; things we have no control over, such as carrying the breast cancer gene; and things we have limited control over to differing degrees, such as where we live. We think it is reasonable for people to decide for themselves whether they are willing to live with these risks, or whether they want to take action to reduce those risks -- whether that's by quitting rugby, having a pre-emptive mastectomy, moving, or losing weight. Both fatness and weight loss can involve health risks and loss of quality of life, and each individual must determine for themselves their own cost/benefit analysis of those risks and that quality. No person can decide that for another.



We do understand that fatness is a health concern -- and we think it should be treated as such, as a public health issue and not as a moral failing or a character flaw. We support social and political changes in the way our society is structured around food and exercise -- changes that will improve the health of people of all sizes. We support bike lanes, cities and neighborhoods designed to be walked in, farmers' markets, accuracy in food labeling, laws prohibiting wild and unsubstantiated claims in the advertising of weight-loss products, yada yada yada. We passionately support healthy eating and exercise programs for children, since fatness in children can cause even more long-term harm than it does in adults... and is easier to address as well, at an age when set points and eating/exercise habits are more malleable. And we oppose the American food-industrial complex's use of psychological manipulation to sell excessive amounts of unhealthy, highly- processed, non- nutritious food, and their prioritization of profit over all other concerns.



Finally: We want to base our movement on the best understanding of reality we can get. We encourage people of all sizes to base their cost/ benefit decisions about food, exercise, and weight, not on wishful thinking, but on a realistic assessment of the best hard data currently available. We support careful, rigorous, unbiased scientific research into why people come in different sizes, and why sizes vary not only from person to person but from culture to culture. We support careful, rigorous, unbiased scientific research into maintaining and improving people's health at the size that they are. And we also support careful, rigorous, unbiased scientific research into safe, sane, effective weight loss for people who choose to pursue it. Our bodies, our right to decide.

Now. Here is a fat-positive manifesto I can't live with:



Weight loss never works. Never, never, never. Virtually nobody successfully loses weight and keeps it off for the long term; the number of people who successfully lose weight and keep it off is statistically insignificant. Weight is entirely or overwhelmingly determined by genetics, and behavior and environment have virtually nothing to do with it. There are no serious health risks caused or exacerbated by being fat: health problems that appear to be caused by fatness are always really caused by something else. And if there are health problems caused by fatness, they can always be better addressed by some method other than weight loss. Even when weight loss is successful, the harm done by it -- physical, psychological, or both -- is terrible: so terrible that, in all cases, it completely outweighs the benefits. If weight loss happens naturally, as part of a healthy diet and exercise program, that's fine. But nobody should ever consciously attempt to lose weight, under any circumstances. People who are attempting to lose weight, for whatever reason, even to address serious and immediate health concerns, should be actively discouraged from doing so.

In my recent discussions of weight loss here in this blog, the fat positive movement responded vociferously with this second manifesto, both in comments and in private emails. And here's why I can't live with it:

It is completely out of touch with reality.



It is flatly absurd to argue that nobody ever successfully loses weight and keeps it off for the long term. Just in my life, in my not- very- large circle of immediate friends and family, I could name you a dozen or so people who have lost weight and kept it off for years. And as far as I can tell, they are not psychologically damaged: they seem to be fine and healthy (or if they're neurotic, they're no more neurotic than they were before they lost the weight). Yes, they're in the minority... but it's not an insignificant minority. It's a big enough number for me to pay attention to. And the studies on weight loss support this: most people who try to lose weight either fail or regain it in the long run, but there are a handful of people who succeed.



There's a weird circularity to the arguments as well. "Weight loss never works... but when it does work, it's harmful... but even if it would be beneficial, it doesn't matter, because it never works." And the arguments are rife with logical absurdities. If set points can get re-set upwards with crash diets or poor eating and exercise habits, then why can't they be re-set downwards? If it's okay to accidentally lose weight as a side effect of a "health at every size" food and exercise plan, then why is it so unhealthy to consciously lose weight... even if the "conscious weight loss" plan is identical to the "health at every size" plan? If weight is genetically determined and diet and exercise have nothing to do with it, then why have Americans become so much heavier in the last 50 and indeed 20 years... and why do other cultures who start eating an American diet almost immediately start putting on weight?

But this second manifesto isn't just unrealistic, or circular, or logically absurd. It seems to be unfalsifiable as well. Here's what I want to ask the fat-positive movement: What evidence would convince you that you were mistaken? How many people would have to successfully lose weight for you to change your mind about it never working? How long would they have to keep the weight off for you to change your mind about it not being sustainable in the long run? And what would you consider as valid evidence that they haven't been psychologically damaged by the process?



Or are you just going to keep moving the goalposts? Are you just going to make the No True Scotsman argument? Are you just going to argue that nobody successfully loses weight... and that people who do are suffering from eating disorders or other psychological damage? Or that if they seem healthy and happy, they're psychologically scarred on the inside, or have sustained unseen but serious damage to their health that will ruin their lives in years to come? Are you going to argue that conscious lifelong attention to weight loss and weight maintenance is an eating disorder by definition? Or that the people who do sustain healthy long-term weight loss are statistical flukes and don't count?

Is there any way that your hypothesis could be proven wrong?

Because if there isn't, then that's not a hypothesis. It's an article of faith. And there's no reason I should take it seriously.



In addition, an unsettling tendency has apparently developed in the fat-positive movement: a tendency to take the most extreme positions -- no matter how logically absurd or morally repugnant -- simply to avoid having to concede any points whatsoever. Many fat-positive advocates insist that weight loss never, ever, ever works. Others insist that there are no health problems caused by any degree of fatness. Still others insist that even if some health problems are caused or exacerbated by fatness, weight loss is never, ever, ever the more healthy choice for anyone to make. Ever. Even if you weigh 400 pounds and have had three heart attacks… you still shouldn't try to lose weight. And if you're me, if you weigh 200 pounds and are having serious mobility impairment due to knee problems and have exhausted all other treatment options for it... forget about it. It's better to have a fourth heart attack, it's better to gradually lose mobility over the years to the point where you can no longer climb stairs or walk more than a block, than it is to try to demonstrate that any belief of the fat-positive movement might be mistaken.



I was frankly shocked at how callous most of the fat-positive advocates were about my bad knee. I was shocked at how quick they were to ignore or dismiss it. They were passionately concerned about the quality of life I might lose if I counted calories or stopped eating chocolate bars every day. But when it came to the quality of life I might lose if I could no longer dance, climb hills, climb stairs, take long walks, walk at all? Eh. Whatever. I should try exercise or physical therapy or something. Oh, I'd tried those things already? Well, whatever.

I'm going to repeat something from my first manifesto, the good manifesto. It may have gotten lost in the shuffle, and it's important, so I'm going to call it out here:

Both fatness and weight loss can involve health risks and loss of quality of life, and each individual must determine for themselves their own cost/benefit analysis of those risks and that quality. No person can decide that for another.

Yes, this manifesto applies to rabid weight-loss advocates: people who insist that anyone who's even 20 pounds over the medical definition of a healthy weight should start losing immediately, even if their blood pressure and blood sugar and cholesterol and joints and exercise habits and family history of heart disease are all totally fine. But it also applies, every bit as much, to the fat-positive movement. It is not up to you to decide for me that the costs of losing weight are greater than the costs of losing my knee. It is not up to you to decide for me that the long odds against successful long-term weight loss (roughly 10 to 1) mean that my attempt to treat my bad knee by losing weight isn't worth it. My body. My right to decide.



Let me ask you this. If you read a post from a blogger saying that they were a heavy drinker, but it was adversely affecting their health and they'd decided to quit... would you send them comments and emails saying, "Don't bother, it's a waste of time and energy, the overwhelming majority of problem drinkers who try to quit eventually fail, and the ones who succeed get obsessed with it and have to go to all these meetings for the rest of their lives and aren't any fun to be around any more, and anyway the connection between heavy drinking and poor health has been totally made up by our anti- drinking society, so instead you should just focus on being the most healthy drinker you can be"?

If not -- then why would you say it to someone who's losing weight?

And here's the thing I've begun to realize about the "weight loss never works" mantra:

It's not actually very fat-positive.

In fact, it's actively fat-negative.

The stubborn insistence that healthy, sane, long-term weight loss is impossible -- in flat denial of evidence to the contrary -- seems to concede that if fat people could lose weight, then therefore they should. It's essentially conceding that the only valid justification for being fat is that fat people have no choice. IMO, it's a whole lot more fat-positive to say that people have the right to decide for themselves whether the difficult, time- consuming, attention- consuming, "10 to 1 odds against success" process of weight loss is something that's worth pursuing.

I do think I see where a lot of this stuff is coming from. Our culture is powerfully biased against fat people and fatness; and even when they are being moderate and evidence- based, the fat-positive movement often gets dismissed as wackaloons, by both the medical community and the culture at large. So given that they've largely been ignored even when they make valid points, I can see how the movement would become increasingly insular, increasingly unwilling to listen to anyone but one another.



But that's no excuse. I am here today, not as an outsider, but as a fat person, and as someone who has thought of herself as both fat and fat-positive for many, many years. And I am saying to you now: It is possible to be fat-positive and still acknowledge that being fat does carry some serious health risks. It is possible to be fat-positive and still acknowledge that some people do successfully lose weight and keep it off. And it is possible to be fat-positive and still be supportive of people who are trying to lose weight. Being fat-positive doesn't require you to treat people who disagree with you as objects of excoriation or pity. And being fat- positive doesn't require that you deny reality.

Now, I'm sure some fat-positive advocates are going to insist that their position is reality- based, and they're going to point to papers and books supporting this conclusion. To them, I say in advance: Yes, you can find papers and books supporting the idea that weight loss never works and is always harmful. You can also find papers and books supporting the idea that vaccines never work and are always harmful. You can find papers and books supporting the idea that global warming isn't real, and that even if it is, it isn't caused by human activity. You can find papers and books supporting the idea that the moon landing never happened. You can find papers and books supporting the idea that the earth is flat.

But that's not the scientific consensus.

And as a skeptic, I need to be informed by the scientific consensus.



Yes, the scientific consensus could be wrong. It certainly has been in the past. Scientists are fallible humans, shaped by the biases of their culture... and our culture is very strongly biased against fatness and fat people. The overwhelming scientific consensus that fatness is a major contributing factor to a whole host of serious health problems... that could be wrong. Or it could be exaggerated. Or it could be right when it comes to some health problems, wrong about others. Or it could be getting the nuance wrong: it could be right about fatness being one co-factor, but wrong about the emphasis it places on it compared to other co-factors. There are some real problems with the ways medical researchers have studied the health effects of fatness: they tend to conflate moderate overweight-ness with serious obesity, for instance, and they often don't control for different eating and exercise habits among people of similar sizes. And an important part of the scientific method is questioning and opposition -- both from inside the scientific community, and from smart laypeople outside it.



But if the fat-positive movement wants to be a serious voice of opposition to the current scientific consensus, it needs to stop denying reality. It needs to stop with the circular reasoning, the cherry-picking of data, the "all or nothing" thinking, the taking of good ideas to ridiculous and repugnant extremes, the logical absurdities, the elaborate rationalizations, the insularity, the flat denial of simple facts that are staring them in the face. It needs to be willing to follow the evidence wherever it leads... even if where it leads is unpleasant or upsetting. It needs to stop with the true believerism. It needs to treat the principles of fat positivity as hypotheses that can be debated -- not as articles of faith.

And I heartily wish it would do that.

Because we really, really need a sane, evidence- based, reality-based fat-positive movement.

I completely stand by my first manifesto. I think these are important issues, and I think we need a social and political movement that's speaking out about them and is working to address them. And just speaking personally: I want and need a fat-positive movement. The smarter, more reality- based ideas of this movement have been invaluable to me: they helped keep me sane and happy as a fat person, and they taught me to think of my fat body as valuable and worth taking care of. And even when I've lost all the weight I plan to lose, I'm still probably going to be seen by most people as overweight. I could really use a community that supports me in my new size as much as it did in my old one.



But in my years as an atheist and skeptical blogger, I have learned to tell the difference between thoughtful disagreement and close-minded true belief. I have learned to recognize denialist crazy. And as it stands now, the fat-positive movement has really started bringing the crazy. It's moving away from being a serious voice in the social/ political/ medical worlds, and is instead becoming an insular, cultish community that only listens to itself. It has taken some very good ideas and has completely run off the rails with them. It has become utterly unconvincing to anyone who isn't already predisposed to agree with it. Hell, it's not even convincing to me -- and I agreed with it just three months ago. I started writing about this issue, in part, to figure out what I thought about it: to think out loud, to get some new perspectives, to hear the best arguments from both sides and refine or rethink my own shifting ideas. And nothing the fat-positive advocates have said so far, in either comments or private emails, has convinced me that I'm wrong to try to lose weight. It has, instead, convinced me that the movement has gone off the deep end.

I really, really want to be part of a sane, evidence- based, reality- based fat-positive movement. But it looks like I may have to find a way to do that on my own.

