Feature image by digicomphoto via Getty Images
Author’s Note: The word “obesity” is used in the source materials for this article and also shows up here.
There was a moment in my early teens where my mom was seriously considering putting me through bariatric surgery. My mom had been sorely misled to believe there is a correlation between being thin and being healthy, and it led to a lot of panic about my fat body. At that point, we had been to doctor’s appointment after doctor’s appointment to try to figure out the reason why I was either gaining or not losing weight despite many changes we were making to, mostly, my diet (since I was already a fairly active kid). A trip to the endocrinologist for a diabetes and thyroid screening that proved fruitless as possible reasons for the changes — or lack thereof. In 2002, bariatric surgery was much less common than it is now, though it was gaining some popularity as a realistic suggestion for weight loss and “‘obesity’ management.”
That summer, we went to a presentation at the Cleveland Clinic center near where we live. They went through the types of procedures available, the costs with and without insurance and, at the very end, the side effects of the surgeries. I was mostly bored and a little bit angry we had to be there. In my mind, this was never going to be something we could afford, so it didn’t seem imminently threatening or particularly traumatizing at the time. But I noticed something quickly shift in my mom’s demeanor when they started talking about the possible side effects: gallstones, hernias, malnutrition, food intolerance, low blood sugar, asthma, ulcers, bowel obstruction, and something terribly named “dumping syndrome” among many others. When the presentation ended, we walked back to the car quietly, she put on her seatbelt, grabbed the wheel with both of her hands and took a deep breath. “Yeah, we’re not doing that, Stef,” she said as she put the car into gear and we drove away. We didn’t talk about it much after that, but it felt like she was fearful of making a decision about my young body that could change the way I live my life entirely.
This seemingly small blip on the timeline of anti-fatness I’ve experienced over the course of my life isn’t something I think about often, but it did rush to the forefront of my mind a couple weeks ago when news broke that the American Academy of Pediatrics (AAP) has changed some of its guidelines for the treatment of children and young adults experiencing “obesity.” The new guidelines, which follow and are based on the bogus and increasingly obsolescent Body Mass Index (BMI) measurement, do suggest some actually useful things we should be doing in our society in general — like increasing the availability of highly nutritious, satiating foods for kids and families who need it and encouraging kids to spend more time doing activities and socializing — but they also suggest more aggressive treatments like weight loss pharmacotherapy and bariatric surgery. They suggest putting kids as young as 12 on weight loss drugs and allowing kids as young as 13 access to bariatric surgery. In fact, the doctors who helped write the guidelines suggest starting these treatments as early as possible because “waiting doesn’t work.”
If you’re feeling pretty weird about all of this, that’s a good thing. As we know, the weight loss industry — not necessarily the act of weight loss in and of itself — is extremely fatphobic and anti-fat. A brief look at weight loss and wellness culture will show you there’s an answer for every weight loss related need you might have. We have surgery and pharmaceuticals for people who have otherwise tried everything else. We have fad diets that fit just about any lifestyle anyone could possibly have. We have therapists and counselors and dieticians to help people manage their mental and emotional responses to stress and food. We have companies that make compression clothing specifically for people who have experienced dramatic weight loss that altered the shapes of their bodies. We have talk shows and podcasts and juice cleanses and tummy teas.
I want to be clear in saying that what people do with their bodies is up to them. I’ve had to make several changes in my own life recently in order to prevent some impending complications to my health. But I also think it’s important to realize that just like any other industry, the purpose of this one is to maximize profits and ensure our dependency on it. This move by the AAP is a good example of how far up the ass of Big Pharma the medical industrial complex is and how capitalists will stop at nothing to keep the system alive. And it’s a lot more than that, too. Some of these surgical “interventions” are irreversible, have long-term side effects, and have long-lasting impact on the body that could potentially impair a young person’s development. What’s even more concerning about these treatments is that a lot of the commentary from doctors who created these guidelines seems to imply that it is the parents’ responsibility — and their choice alone — to get their kids started on these intense treatments.
Anti-fatness and fat stigma are ingrained in every single aspect of our society. Anti-fat bias makes is harder for fat people to find employment and get promotions; it prevents them from earning the same salaries as their thinner counterparts; it makes it less likely for fat people to receive the proper care from doctors and other medical professionals; and of course, it often leads to social exclusion and bullying by peers, adults, and family members. Historically, made-up social hierarchies and stigmas regarding bodies and body features are rooted in racism and designed to impose oppressive forms of social control. Anti-fatness is based on the same principles of social control. The purpose of the perpetuation of anti-fat oppression is to create a society that fears and demonizes fat people. Fatness is deemed “immoral” in our society, which means that while this is about money, it’s also about policing morality and governing the ethics we adopt to live our lives. The most obvious and glaring issue with that is that when you make someone’s existence immoral, the society around them conforms to those ideals as well, which directly contributes to the negative health (and just fucking life) outcomes of fat people.
When you juxtapose the AAP’s new guidelines with the fight against trans kids’ rights to make decisions about their bodies, you can especially see what I mean by this. In the same way that fatness is deemed a moral failure on the part of fat people, being trans is also seen as a moral failing on the part of trans people. Where trans kids and their families are being made to feel as if they don’t have the medical (or emotional or social) authority to pursue treatment that would help improve their lives, fat kids and their families are being told that they must pursue treatment for “obesity” as soon as possible in order to “overcome it.” This current moment is a frustrating and genuinely terrifying study in the use of biopolitics as a weapon to control the trajectory of the many distinct and overlapping social classes. Giving parents the option of making their children take weight loss drugs or get bariatric surgery isn’t about making kids “healthier.” Just like taking away the possibility of gender-affirming care isn’t about making kids “healthier.” It’s about taking away people’s sense of bodily autonomy so they’re easier to control. In these cases, they’re starting at an extremely young age.
And you know what the worst part about it is? Y’all fall for it every single time. People will keep acting as if anti-fatness isn’t an actual form of oppression. People will keep acting like standing up for fat people isn’t a necessary and powerful and empowering thing for them to do. People will undoubtedly look at this as a good thing, as a thing that could potentially improve the health outcomes and longevity of a lot of people’s lives. While it might be true for some people that seeking these treatments are just for that, the suggestion — really, the insistence — to use these treatments on young people by the biggest pediatric association in the country is connected to a much larger history and system of institutionalized violence that puts the lives of fat people in danger every single day.
Thank you Stef for laying out how what’s going on with body autonomy, social control, and capitalism mean that ‘contradictions’ in anti-fat and anti-trans policies are not contradictions at all, and the antiBlackn roots in this. Its helpful to see this on a page instead of just ricosheting around my mind, heart and frustrated waving hands.
the links between fatphobic and antitrans policy reminds me of “we autistics, we villages, we humanoids” by queer writer Jen Meunier (Gzhibaeassigaekwe), published in “All the Weight of Our Dreams: On Living Racialized Autism.” i can’t do this essay justice here, but she explains anti-autism is JUST one facet of the white supremacist & colonialist requirement to attack <> both among humans (attacking & constraining bodies that are fat, trans, black, brown, disabled, and more) and outside of humans (environmental destruction, monocrops, etc).
(oops html parsing gobbled a very impt word) .. . . the white supremacist & colonialist requirement to attack BIODIVERSITY both among humans . . .
Thank you so much for this Stef. This is truly scary!!
Big thanks to Stef and AS for covering this and with this lens (these many lenses!).
Thank you, Stef!
Thank you so much for this Stef!
stef, i am so glad you’re here, putting this all into words. this shit is terrifying and i hate it!!!!!!!
I am so glad that AS has regularly started to talk about anti-fatness like this, and am so glad your voice is here, Stef! Love yoir work.
I would love to see even more fat queer writers like Ragen Chastain who have explored the jaw-dropping ways that Novo Nordisk has bought influence with the AAP and corrupted the anti-weight stigma conversation to be that “we should give fat people drugs for their whole lives to make them slightly less fat” instead of “we should stop stigmatizing fat people and prescribing expensive and dangerous interventions with zero proof they make us healthier.”
For every New York Times article praising Wegovy as a way to fight weight stigma, I hope we have an Autostraddle article pointing out the ways that anti-fatness is white supremacy in action!
Has Ragen Chastain stopped grifting off her readers, falsifying her credentials, and exaggerating her athletic accomplishments, tho?
Do you have any links where I can learn more about this?
LOL, yeah, no thanks anti-fat troll, y’all show up every time and any where that Ragen is mentioned with zero proof of anything you allege. It’s a lot of energy going into smearing someone who is truly wonderful just because you hate fat people, but TBH I know Ragen can take the heat and is probably glad to do it so others don’t have to.
I understand it’s much easier for most readers to not even look at the actual guidelines, and just read this 500 word opinion-piece, written by someone seemingly unqualified, or unwilling, to discuss evidence and methodology.
However, for anyone actually interested in the EVIDENCE, PLEASE look at the full 100-page document yourself, or at least look at the figures. It’s available for free. Understandably, it’s a huge piece of work that took years to complete, so I’m noting the main parts here for you:
• “FUNDING: No external funding. FINANCIAL/CONFLICT OF INTEREST DISCLOSURES: An Independent review for bias was completed by the American Academy of Pediatrics. Dr Barlow has disclosed a financial relationship with the Eunice Kennedy Shriver National Institute of Child Health and Human Development as a co-investigator.”
• Page 3: the authors explain their approach and go into health equity, racism, weight bias and stigmatisation, and adverse childhood experiences
• Page 5: definitions of terms
• Page 6: METHODOLOGY, including how to judge evidence quality (hint: personal anecdotes and opinions, or podcasts = garbage)
• Page 11: Epidemiology
• Page 12: Diagnosis and measurement – including explaining BMI strengths and weaknesses, and DEBUNKING the author of the think-piece
• Page 15: Risk factors
• Page 26: Evaluation
• Page 33: COMORBIDITIES (including treatment)
• Page 47: TREATMENT OF CHILD AND ADOLESCENT OVERWEIGHT AND OBESITY -which lists many other therapies before we finally get to…
• Page 60: PHARMACOTHERAPY: THEY CLEARLY STATE LACK OF EVIDENCE AND DO NOT RECOMMEND IT AS MONOTHERAPY, BUT ONLY FOR EXTREME CASES WITH COMORBODITIES AND “according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.”, and with appropriate oversight AND significant input from the patient!
• Page 62: SURGERIES: They discuss UP-TO-DATE harms and benefits and STATE: “This action statement does not recommend surgery for all who have severe obesity but rather the opportunity for children, adolescents, and families to consider and undergo evaluation.”. BASICALLY THEY DO NOT RECOMMEND IT UNLESS VERY EXTREME CASE, FAMILY HAS BEEN GIVEN ALL THE INFO AND THEY WANT IT.
• Page 65: Systems of care
• Page 67: Barriers
• Page 68: EVIDENCE GAPS
• Page 70: CONCLUSION
• Page 73: REFERENCES (n=801)
VERY disappointed in Autostraddle for publishing opinion-pieces like this around health, because they basically use the same tactics as anti-vaxxers: conspiratory thinking, anti-science, anti-“establishment”, no-quality evidence.
Thank you!
Thank you so much for this more accurate summary of the newly published paper. I hate when scientific research papers like this one are badly summarized and reported on with a political slant.
WOWOWOWOW. News flash: there’s actually a SHIT TON of *scientific* evidence that BMI is garbage (it was never meant to be a medical indicator of anything), fatness has nothing to do with “health” (not that people deserve to be treated like shit for being unhealthy anyway) and that LONG TERM WEIGHT LOSS IS ACTUALLY IMPOSSIBLE FOR THE GRAND MAJORITY OF THE POPULATION AND IS THEREFORE NOT A USEFUL STRATEGY TO MANAGE ANY TYPE OF HEALTH CONDITION. If you bothered to actually pull your head out of your ass to research this topic in any kind of real way you would find that actually there are a ton of articles and entire books (not just podcasts!) breaking down the methodology of these studies and explaining why most of the evidence used against fat people is not actually meaningful. SCIENTIFICALLY. Also the evidence about weight loss surgeries is incredibly disturbing and violent and these surgeries actually do not achieve much except severe health complications and possible death! Please don’t pretend to be knowledgeable about ~science~ when discussing a subject you clearly know nothing about. And yes I do have a graduate degree and can understand research methodologies just fine while still caring about the impact of science (a white supremacists institution) on actual human beings, thanks.
I didn’t find the original comment you were replying to to be hateful, or to be advocating for treating people like shit. I think it is (at best) not useful to get this heated when someone is simply expressing a different opinion from yours. I think if you are trying to educate someone instead of saying things like “If you had bothered to pull your head out of your ass to research this” you could let them know about some good articles and research on the topic.
It’s ok for folks who are affected by hateful and discriminatory policy and rhetoric to get upset when discussing it, and it’s not always their job to provide education. Yes, it may sometimes be useful when one is able to make that space and provide those resources, but it’s not required.
I understand that, but I felt like chiming in here because this is not an in person conversation where your emotions get the best of you and you react in the moment. This is an online discussion, where if you are having a strong reaction to something you read because of lived experiences you are able to step away for a minute and cool off before rage-responding.
I also felt like chiming in because culturally we are at a point where for a lot of people having a conversation about almost any topic feels impossible because no matter how well intentioned a different, but not hateful, opinion is someone is going to rage at you. I think this has been extremely damaging across the board and I wanted to call out an instance of it, so hopefully people will be able to be more mindful in situations where they are not instantaneously responding to another human being.
I understand some topics are harder for people to be level headed about because of their lived experiences, however I don’t think it helps them or other people understand each other better and learn new perspectives when all they respond with is uninformative rage.
My pointing out that more mindful responses to people are generally better is not a statement that people should not have emotional reactions to things, and at no point did I imply that.
hi em! i don’t think it’s the duty of fat people to be civil about the ways our bodies have been pathologized in the name of saving the discourse. <3
I think a big divide here is going to be BMI. There have been many thoughtful research pieces – both historical and scientific – done on the BMI as not being accurate, useful, or without bias. I think it’s also worth considering that to an extent – as long as there are barriers to official knowledge practices (I say as someone with post-secondary education), we have a need to mindfully consider individual anecdote and feedback.
As long as fat is also assumed to be negative for health (which has been proven to be false), programs that automatically view fat as health negative will need to be carefully interrogated.
Something I think about, and invite you to consider, is the history of health and state and impact versus stated intent. There are many, many, many reasons for marginalized folks to analyze health policies with a critical eye and to have a real need to ask questions and be skeptical. I personally really question the evaluation of “extreme cases” and wonder about the autonomy of the youth specifically.
Thanks for sharing this. Although there is definitely a very real anti-fatness social movement out there, healthcare as a whole is intent on untangling themselves from BMI and the social bias.
hi maddie! i’d be curious to hear more about this if you want to share!
Thank you for this!
Things it made me think of: the parallel between the current medical / political system with its anti-fatness, anti-trans, anti-abortion, anti-choice and the the past eugenics movement and social darwinism
How other markers of health similar to fatness aren’t policed the way fatness is. High blood pressure can be a indicator of poor health like fatness can be, but also similarly it’s more complicated than that, and people aren’t stigmatized for their other “poor health indicators” the way fatness is. When people talk about high blood pressure, they always lead with genetics, and then the lifestyle your culture and city planning promotes, then individual choices – the opposite of the views on fatness
Thank you, Stef, for saying exactly what needed to be said on this topic.
Carbohydrates combined with Poly-Unsaturated fats (PUFA / VARNISH -> soybean/safflower/sunflower/corn/seasame/canola/flaxseed/cottonseed/linseed) directly cause cancer, diabetes, heart disease, liver disease, obesity and dementia.
Nobody asked you.
Overweight and obesity are major risk factors for a number of chronic diseases, including cardiovascular diseases such as heart disease and stroke, which are the leading causes of death worldwide. Being overweight can also lead to diabetes and its associated conditions, including blindness, limb amputations, and the need for dialysis. Rates of diabetes have quadrupled since around the world since 1980. Carrying excess weight can lead to musculoskeletal disorders including osteoarthritis. Obesity is also associated with some cancers, including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney and colon. The risk of these noncommunicable diseases increases even when a person is only slightly overweight and grows more serious as the body mass index (BMI) climbs.
Obesity in childhood is associated with a wide range of serious health complications and an increased risk of premature onset of related illnesses. Studies have found that without intervention, children and adolescents with obesity will likely continue to be obese into adulthood.
Hey, actually a lot of this research is deeply flawed and many of these associations can be attributed to the stress of living in a body that entitles people to say things to you about how you are going to die. Also weight loss is not sustainable or an option for 99% of the population so it is not actually a useful recommendation for healthcare. ALSO fat people get dismissed by doctors when they have non fat related health issues and then get way worse healthcare. I encourage you to get a little deeper in your research–there is way more to it than this!!!
Hey! Do you happen to have any intro sources/primers/list of studies for this? I would love to read more but I haven’t really had a chance to dive into the literature. As a fat person who’s had some absolutely horrific experiences at the doctor, I’ve almost jokingly made the point that I wonder if our “negative” health outcomes are more related to medical bias than anything to actually do with our bodies. No worries if you don’t have time to get sources together, just figured I might ask since your comment mentioned it!
A couple among others:
https://pipewrenchmag.com/dismantling-medical-fatphobia/ (CW starts off w describing a child’s traumatic gyno appt experience) [thank you Heather Hogan for sharing in a news round up!!!]
Fearing the Black Body: The Racial Origins of Fat Phobia by Sabrina Strings
Thank you so much! Really appreciate it :)
There’s a lot out there! The Health at at Every Size movement (also known as HAES) is pretty focused on medical fatphobia and these health sheets are fabulous: https://haeshealthsheets.com/. There are also a few different collections of HAES aligned healthcare professionals, oftentimes searching “HAES” and your city name will bring up options, or “fat friendly healthcare” plus your city name.
I mentioned in another comment that Ragen Chastain is a good follow because she loves a good statistical analysis and does a lot of advocacy about getting the healthcare you need without stigma. (She contributed to the health sheets above.) I like her Substack newsletter called Weight and Healthcare, almost all her issues are free. I also love the Anti-Racist Dietitian Substack.
Super approachable podcasts that deal with this and lots of other related topics: Maintenance Phase, Food Psych, Burnt Toast (which also had a fantastic Substack.)
There are so many authors who have gotten into medical fatphobia too — Paul Campos, Lucy Aphramor, Sabrina Strings, Lindo Bacon (who has acted problematically but their work still has its place, I think), Marilynn Wann, Aubrey Gordon, Virginia Sole-Smith.
Thanks so much for the wealth of resources! I have heard of Maintenance Phase but I’ve been a little intimidated to jump into it, so I appreciate some that I can read to ease myself in a little more slowly lol. Thanks!
Thanks for saying this, Cait.
It’s disappointing that AS isn’t doing (any?) moderation to make it clear that concern trolling isn’t welcome here.
Either you want fat people to be a part of this community, or you want the people who are demonstrably causing harm to fat people reading these comments to be. There is no both sides here. You cannot have someone claiming that their fatphobia is about a concern for health when we know (and have known for literal decades!) it actually makes health outcomes worse.
This isn’t someone open to learn. This is someone commenting because they get off on doing harm. Health is not a moral obligation, it is often out of our control, and it is multifaceted besides. Are these commentators who claim they care about fat people’s health also commenting about how pollution causes health issues? Are they commenting on stories about sports that have high rates of injuries to point out it’s bad for the health of the athletes? Are they commenting on personal finance stories to remind people that being poor is associated with worse health outcomes? Are they commenting on stories about police brutality to tell people that being Black is a health risk? That education level correlates to health? That tall people don’t live as long as shorter people? Oh, you’re just concerned with telling fat people whenever you can that their health is going to be worse because of their body size? That’s interesting.
I get that Autostraddle isn’t flush with cash and therefore the ability to have a full time moderator or even someone doing it daily is unlikely, but they have a fat writer who they surely know is going to get these comments and yet they’re left up. It sends a message to fat people reading, and I am getting sick of supporting Autostraddle financially when this is such a long running problem with the comment threads.
I absolutely agree that policing youth bodies (especially fat bodies) and encouraging (or forcing) change is horrible, whether the force is covert or overt.
I experienced so much fatphobia from the moment I started gaining weight as an early-pubescent 9 year-old, mainly from doctors, family, and peers.
I don’t want to get too much into my story, as I don’t want to cause any harm with my ”unpopular opinion” (as the kids say), but I did have bariatric surgery last year, as an adult in my 30s. It was a personal decision of body autonomy, and it obviously was influenced by societal fatphobia, as we don’t exist in a bubble, but it was also a choice I made for me.
I think there is a nuanced conversation about how to teach young people about body autonomy and how to create conscious, empowered relationships with our bodies, food, movement, etc., in a world where Big Pharma and those they influence have an agenda. I wish someone would have been a role model or taught me these when I was a kid/tween/teen.
I have many complicated feelings about being a body positive, queer feminist who made this choice to have the surgery, and I am happy to engage in these discussions offline/not in the comments section.
If anyone is interested in reading more about this nuance, I recommend Hunger by Roxane Gay and her essay “What Fullness Is” https://gay.medium.com/the-body-that-understands-what-fullness-is-f2e40c40cd75
Take care of yourselves, fam.
<3
It makes me sad that Autostraddle has rad fat writers who share about their experiences, but when a fat person shares about harmful medical fatphobic policies the queers really show their true fatphobic colors in the comments. Defenses of “but science” really are missing the mark because science isn’t neutral or unbiased and is heavily influenced by the oppressive world around us. Wishing perhaps for some doubling down on making that clear in future articles from Autostraddle.