If you’ve been consuming the news about obesity, you can be excused for thinking that being fat = being in bad health = being on a fast train to Bad Things Happening. Why is this the message? First off, it’s an easy one to convey. You fat people are in bad shape. Literally. Your physical presence is at variance with non-fat people, you have a different shape, and that shape is bad. Next, if someone is “in bad shape”, then there’s things going wrong internally, right? They’re not going to make it! (Make what? News flash – we’re all mortals here and even if you believe in an afterlife, you’re not necessarily going to inhabit a form identical to your current physical body. But that’s a topic for another post…) Thus, weight is a reductionist stand-in for the complex biological operations of the body as a whole. Aesthetic measurements supercede medical calculations of health.
It also plays a trick with the overlapping and amorphous meaning of “health.” The term health is descriptive and so is also highly normative. It evokes a sense of medical authority and precision that it can’t really deliver. It’s also increasingly used as a synonym for “weight loss” – Oh, I’m not dieting, you know, I’m just trying to be healthy – usually to side-step the emotionally and morally fraught admission that, well, yup, you’re a lard ass and female and need to man-up and just do this thing. Getting healthy is so much more macho than trying to lose a few pounds.
We do try to make distinctions between healthy and unhealthy states of being, presuming that the healthy state is a better condition than an unhealthy one. Things that are in a healthy state work better, run more smoothly, last longer, perform at a level of excellence or within defined limits than comparable things in an unhealthy state. If you have a simple object, such as a tool, in front of you, it’s likely that you can define the “health” of the object with a high level of specificity. When you have a complex subject in front of you, otherwise known as an individual, her health becomes less a set of rules and more an examination of relationships between different markers that we have decided are relevant to defining health. These markers are psychological as well as physiological and are mostly invisible to casual observation.
No wonder we like to use weight as a proxy. It’s a simple measure, we think we can observe it, and it allegedly accurately represents the invisible inner operations of the person we are examining.
Weight and health are treated as being inversely proportional; more weight = less health. Low weight is our visible sign of grace, something to be condemned in the individuals we don’t like or excused in those that we admire. Loss of weight demonstrates moral fitness as much as physical improvement. You know better than to let yourself go. Losing weight IS becoming healthy.
I think you can see the problem here. When the loss of weight is itself the goal and signifier of health, the only acceptable outcome is physical erasure of the self. No level of thinness is enough, one must always already be in the process of losing, even when your weight is objectively normal. Then it becomes more refined such as loss of body fat percentage, or loss of toxins, or loss of imbalances in the something-or-other.
To refuse to lose weight, or even to deprecate weight loss as part of an overall approach to one’s personal health, is seen as doing harm to oneself and (by virtue of your fatness) to others. Your fat presence is an instance of disease, because you’re are making others uneasy with your rejection of their obsession.
Weight is a component of health, not a representation of it. At most, a person’s weight raises and lowers risk levels for various conditions, mental and physical. Extremes of weight are indicators that specific aspects of a particular person’s health may be in or approaching a harmful state. This applies to weights below a normal range as well as above, but since weight loss is valorized (unless it is done to excess by a female body, in which case we reserve the right to pathologize that, too), the low body weight risks are either ignored or minimized.
If a person is obese, that is an indicator that he has a greater risk of certain medical conditions than someone who is not. It doesn’t mean he has these conditions or will develop them, but that his risk is higher, so tests can be done to make known the otherwise invisible markers. If there is a health issue, then it can be treated (or not). If there isn’t a problem, then off you go on your merry way.
Someone whose only indicator of health risk is her weight can objectively call herself healthy. No heart issues, no lung problems, good blood sugars, great cholesterol, normal blood pressure, all the labs are good, all reproductive organs working as expected, etc., etc. If a person with weight in the normal range and identical test results would, without hesitation, be declared “healthy,” then the overweight person also is healthy. If a person of normal weight but a little bit high cholesterol is considered healthy, why is a merely overweight person confronted with such outrage and moral panic? At worst, the overweight person has a condition she should be aware might be problematic in the future (yeah, like I have any choice except to be confronted with doom-and-destruction news about what my 30 extra pounds are going to do to me and the nation…), just like the woman with high cholesterol, so do what you can now to keep it from getting worse.
The other part of this is the way in which other medical health markers are treated as conditions to be managed – blood pressure, cholesterol – rather than as crises that must be reversed NOW, and if they choose to eschew radical, invasive treatments (or any treatment at all), they are not hauled before the court of public opinion for judgment, conviction and keelhauling.
I’ve had the misfortune to experience a severe medical condition that threatened my life. It was major surgery or death. Period. The costs for treating that single condition dwarfs all other spending on my health over the course of my life. My weight did not cause or contribute to that condition. Indeed, that condition caused me to become obese. There are far, far worse things than being fat.
When I had my last doctor’s exam, the nurse who took my vital signs before the visit started at once started to harangue me about my weight and how I was obese, before I had even stepped off the scale. She continued this while doing my blood pressure and using this finger clip thingy to measure my blood oxygen level (which is fantastic, btw, despite not having an intact right lung). While she was scolding me about the horrors of being fat, she typed my weight into the computer – and was brought up short by a big red warning on the screen and a dinging noise. I was 30 pounds less than at my last visit, and this indicated I might be suffering a health issue. She stammered that she didn’t usually see weight loss in a patient and tried to back away from her fat shaming of just a few seconds before.
All she cared about was a single measure of weight. Not what my other vital signs showed. Not what my weight in the context of my health history indicated. Not that I was a patient with reduced lung capacity who nevertheless is getting enough oxygen. Just that I was a fat cow and needed to be fat shamed in a semi-public hallway outside a bank of exam rooms filled with other patients and medical staff. She reduced my health to my weight, and the worst part of it is she didn’t really think about it. She was on anti-obesity auto-pilot.
My argument is not against losing weight if that is what a person wishes to do for her overall health. It’s what I have been doing for three years. It is against making weight the only health measurement that matters, and reducing people to the numbers on the scale.