CW: in-depth discussion of anti-fatness myths and people’s experiences around body shaming.

Welcome back to installment two of the FIFI book club’s review of You just need to lose weight and 19 other myths about fat people, by Aubrey Gordon. If you missed last week’s post, you can access it below.

FIFI book club: You just need to lose weight, and 19 other myths about fat people

This week, we are talking about section two, which is about health-related myths foisted upon fat people. Here they are:

• myth 6: obesity is the leading cause of death in the US
• myth 7: BMI is an objective measure of size and health
• myth 8: doctors are unbiased judges of fat people’s health. Fat people don’t like going to the doctor’s office because they don’t like hearing the truth.
• myth 9: fat people are emotionally damaged and cope by “eating their feelings”.

Sam’s comments

The second part of Gordon’s book is about health myths related to fatness. She does a good job with the issues which will be familiar to readers of this blog. The one I’d like to chime in on is the one that drives me wild because it’s one I encounter among otherwise progressive, body accepting people. It’s Myth 9, “Fat people are emotionally damaged and cope by ‘eating their feelings.’”

Gordon takes on the concept of ‘emotional eating’ which came into vogue in the 70s and was the way Weight Watchers’ founder Jean Nidetch framed her own journey to weighing too much. On this view of overweight and obesity, fatness comes to be as a response to trauma. Fat people have endured horrible experiences and turn to food for emotional comfort. Deal with the trauma, cease the emotional eating, and a normal body size will emerge.

Of course, while this matches the experience of some fat people it’s too simple in a few different ways. First, it ignores the genetic aspects of our body size and in families, you’ll see people who have different experiences, not everyone has a traumatic childhood, but many or all of the family members share a body size. Second, lots of people engage in emotional eating and don’t get fat. Emotional eating may not always be a healthy response to the bad stuff in our lives but it doesn’t necessarily lead to weight gain.

To this I’d add the thing I’ve blogged about, not all emotional eating is unhealthy. 

See also Four worries Sam has about intuitive eating. Here I raise the worry that the emotional eating framework becomes yet another way to judge and blame fat people, especially fat women.

“You’re supposed to only eat because you’re hungry. Intuitive eating, done right, is supposed to land you at the right weight for your size (see above). Therefore, larger people must be eating for reasons besides hunger. You’re supposed to be vigilant about emotional eating. So often there’s judgments about mental and emotional health of fat people, as if we can read your emotional well-being off the number on the scale. It assumes that if you take care of your mental and emotional health your weight will fix itself. And that you can tell that people–and here pretty much we mean women–are emotionally unstable, because they’re fat. Just no.”

See also Catherine’s Comfort eating– it’s not gonna kill you, and may even be beneficial (says science)

To sum up, I liked this section on health but I think you almost need a whole other section on myths about emotional health and larger bodies.

Diane’s comments

This section didn’t hold a lot of surprises. I really liked the attempt to asses the causality of obesity related to various diseases. As I now deal with arthritis-related joint pain and high blood pressure, I get anxious about whether I could be doing something more to help myself. I would happily have read a lot more about this topic as I’m still not confident I understand all the nuances around where there are legitimate causal links (while fully supporting the well-argued case that fat does not necessarily cause disease and that many other factors including poverty and genetics are at play).

The one surprise was in Myth 8. I have heard from friends abut their experiences with doctors demonstrating anti-fat bias by dismissing health concerns and focusing instead on their weight, but I didn’t know that getting this short shrift was a literal thing – fat people actually have shorter appointments.

Amy’s comments

The second section was just as informative as the first, and Gordon tackles some great myths here. One of the ones that struck me was Myth 8 “Doctors are Unbiased Judges of Fat People’s Health.” As we know is true almost universally, humans are biased. We are all produced in particular systems and structures that often lead us to bias, both conscious and unconscious. Doctors are no different. Here Gordon goes on to provide data taken from medical training environments regarding people with higher weights and larger bodies. She offers studies in which some of those bias were reduced with small tweaks to the environment or educational information.

I’m often stymied by friends, many of whom are academic researchers themselves, who take information from their medical doctors at face value. Even when they are told by others that the info may be biased or out of date, they insist that the physician must be correct simply because they are a doctor.

One friend in particular was told by an “ob*s*ty specialist” that they would die if they didn’t reduce their body weight. They embarked on a lengthy “treatment” process of what was essentially a (reduced) calories in/(elevated) calories out model. When confronted with the notion that a) this doc was making a (lucrative) living off convincing higher weight folks that they need to lose weight and b) the dangers and stats on weight cycling, the friend doubled down by insisting that they “just didn’t want to die.”

The fear mongering that can happen in the medical community around weight and body size is truly astounding to me, and Gordon captures quite a lot of the foundation for these tactics in this chapter.

The chapter on emotional eating also stuck out for me, not so much because of the negative valence attached to emotional eating (though there is that too) but for the identifying of the assumption that anyone who is fat must be engaging in it. This chapter does a great job of really pulling the curtain back on the way no one questions “naturally thin” people but the default assumption about someone fat is that they must be doing something “wrong” (in this case engaging in “emotional eating” in response to trauma).

Tracy’s comments

The chapter on emotional eating also stuck out for me, not so much because of the negative valence attached to emotional eating (though there is that too) but for the identifying of the assumption that anyone who is fat must be engaging in it. This chapter does a great job of really pulling the curtain back on the way no one questions “naturally thin” people but the default assumption about someone fat is that they must be doing something “wrong” (in this case engaging in “emotional eating” in response to trauma).

In general this book has so far been a been a very uncomfortable read for me as someone who has relative thin privilege and who has been a proponent of intuitive eating.

And here are my (Catherine’s) comments

These days, I spend a good bit of my professional research and speaking time on myths 6 and 7, giving talks and writing about 6) how higher body weights are not (I repeat, not!) correlated with all-cause mortality; and, 7) how BMI is not (I repeat, not!) an indicator of health. Gordon’s chapters on these myths are superbly done and precisely documented with studies to back up her rejoinders to these entrenched myths. Her citations are but a small sample of the comprehensive literature showing that the relationships between body weight and mortality risk, and between body weight and disease are not simple and are not linear. They are complex, nuanced, and modulated by genetic, genomic, environmental, and other factors.

Yes, science is complicated. And the science of human metabolism is especially complicated. But anti-fat bias plus the desire for simplicity drives medical beliefs and practices that have been oversimplified to the point of falsehood.

Take BMI as an example. It’s easy to calculate someone’s BMI. All you need are a tape measure (for height), a scale (for weight), and a BMI table. Anyone in any primary care practice can measure and weigh people reasonably accurately and very cheaply. So BMI is a cheap and easy metric to use. The problem is, it doesn’t actually measure what medicine and public health are looking for, which is something like “risk of disease/death due to degree of fatness or thinness or body shape, relative to height”.

I am here to tell you today that IF there were some biometric(s) that predicted disease or mortality risk in virtue of one’s size or amount of fatness or type of fatness or distribution of bodily fatness, they wouldn’t be simple or easy or cheap to measure. We know this already: there are loads of studies that use metrics like fat-free mass and others to investigate their possible correlations with e.g. mortality risk. Based on initial research, those possible correlations are complicated, change during the life course, and they require very expensive equipment not found in doctors’ offices.

As of right now, medical science doesn’t have any easily accessible, clearly interpretable, agreed-upon metrics that predict disease or mortality risk due to fatness. When I’ve given talks to physicians’ groups about how bogus BMI is, they (sometimes grudgingly) accept the data, but during the Q&A a few will inevitably fall back on the assumption that increased body weight is always a negative medical indicator. I get that healthcare providers are constrained by time, insurance billing codes and regulations, and the need to address complex and urgent health problems with limited tools. But BMI is just not one of those tools. It’s a blunt object, and every single fat person (myself included) is done with being bludgeoned by it.

Readers, are you reading this book? Do you have any thoughts about this week’s myths? Let us know.