WIN Wyoming

Thought Bullets
for
September 2006
 

Anti-obesity vs. Fat Acceptance - Weighing Both Sides, Part One 

A few months ago, Sylvia Moore, Director of the WWAMI Medical Education Program at the University of Wyoming, alerted me to an article from last year that did a masterful job of sorting out the two major approaches for addressing obesity. I’ve now read the article three different times and want to share with you some of the points I found to be the most insightful for me.

• The authors conclude that morality as much as mortality plays a central role in the controversy over how obesity is perceived. Those in the anti-obesity camp see body weight as something that is under personal control and therefore they argue people have a responsibility to manage their weight. Those embracing the fat acceptance approach view fatness as natural, and largely inevitable for some people, and therefore they argue that large body sizes are one type of human diversity.

• Several studies have documented that higher body weights are more common among lower socioeconomic groups with African American and Mexican American women among the most likely to be obese. Fat acceptance promoters argue that blaming fat people for their weight serves to reinforce social inequities. It is difficult to be physically active when one lives in a high-crime area and can not afford a gym membership.

• Many obesity expert panels (National Institutes of Health, Food and Drug Administration, World Health Organization, etc.) are dominated by anti-obesity researchers suggesting that much of the current research on obesity may have a bias against a diversity of hypotheses being tested.

• To understand how the anti-obesity and fat acceptance approaches view the same findings differently, the authors offer the often cited 75-95% failure rate for people attempting to lose weight. The fat acceptance approach argues the high failure rate is proof body weight is outside of personal control for most people. On the other hand, the anti-obesity approach argues that a 5-25% success rate proves that weight loss is possible, although difficult.
• The national debate continues over whether or not obesity should be considered a disease. If considered a disease, weight-loss treatments such as surgeries could be covered by medical insurance and Medicare. On the other hand, some fear that labeling obesity as a disease suggests fat people should always seek medical treatment, even if it is risky and has a low probability of success.
• Since the 1990's, obesity is the U.S. has been labeled an epidemic, with a large number of people reaching a body mass index (BMI) of 30 or higher. Some researchers are now suggesting that the term epidemic does not truly represent what occurred with changes in BMI over time.  These researchers point out that the average person gained only seven to ten pounds over a ten year period. Over the years, more and more people were inching ever closer to the arbitrary BMI of 30. Thus, the current rise in obesity is seen less as an epidemic and more as a steady but constant rise in body weight over time for most people.
• Some individuals promoting the fat acceptance approach fear a focus on body weight can be counterproductive to promoting healthy lifestyles. Body size is not a reliable indicator of a person’s healthy eating habits or level of physical activity. People who improve their diet and become more active do not always lose weight. There is also fear that a focus on weight will not only lead many to pursue dangerous weight loss treatments, but will also increase eating disorders and rates of smoking as people try to achieve smaller bodies.
• Anti-obesity promoters don’t buy the argument that anti-obesity approaches will cause a dramatic increase in eating disorders. They argue that eating disorders are mainly concerns of upper-middle class women, and most of the targeted information about obesity should be directed to the poor.

Source: Saguy AC, Riley KW.  Weighing both sides: morality, mortality, and framing contests over obesity.  Journal of Health Politics, Policy and Law, 30(5):869-921.

Compiled by Betty Holmes, MS, RD

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