Framing fatness as a disease: why this is a problem

May 08, 2023 | Body, General, Self Care, Self-worth

At the beginning of the year, there were a couple of videos going around in some fat liberation spaces about an interview on CBS’s “60 Minutes”. In the interview, they discuss fatphobia in the medical system, and how most physicians do not understand what makes larger bodies happen. At the same time, they make causal relationships between body size and illnesses, and the whole debate reads to me as an ad for a new drug. I wasn’t very happy with this. Today, I’d like to discuss some of the themes brought up in the conversation and why I think they missed the mark by discussing fatness as a disease.

Fatness and disease

The CBS interview spends a significant portion discussing fatness as a disease, as well as framing it as the cause of other illnesses. I take issue with both.

The first problem is that it assumes that a fat body is sick. There is evidence for healthy fat people, with up to 30% not having any diseases. Ironically, researchers seem to see the data and conclude fatness is still wrong. The conversation is ongoing but, in general, we can’t assume a person’s health by a simple look. Our body volume isn’t enough to predict health status.

Another issue is that it pathologizes a state of being, so it doesn’t really do much more than repackage fatness as a problem to be fixed. It tells us, “it’s not your fault, but you still need to fix this.” It doesn’t do much to prevent shame; it moves it from fatness as a problem of weak wills, to fatness as a problem of lack of health.

I will say, I liked that the interview highlighted the genetic influence in our weight. Of course, our size is much more complex than that; environment and social determinants of health are an important factor as well. While it’s good that there’s a conversation about fatphobia in the medical system, I don’t think it’s a good idea to focus on fatness as an illness. It may reduce shame for fat folks, as it can be liberating to understand that their bodies are fat because of a mix of DNA and environment. But to frame disease as a problem is an issue in itself.

Fatness and health

I don’t think I’m wrong when I say that a majority of people who’ve been called or perceived themselves as fat have tried, at some point, to shrink their bodies. It’s also true that some of us, after doing fat liberation work, have learned to be neutral about our body. Some of us have grown appreciative of it. Still, we all must live in a world that judges our body size as a measure of our goodness.

Over the past few decades, people moved from objecting to fatness based on aesthetics to thinking of it in terms of wellness and health. But what is health, really? When we think about it, it’s a notion that goes beyond the absence of illness; in fact, the WHO defines it as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity“. In other words, health is about thriving.

No wonder we all aim for health! Still, it is part of the human condition that we will get sick. From a simple cold, to breaking a bone, to the mental health impacts of social isolation, we will all face disease. Especially as we age, and our bodies don’t work as well as they used to. Sadly, in moralizing health, we’ve put the cause of illness in our behaviours. We’re better if we’re healthy, because we’ve done well. If we’re sick… what did we do wrong?

Healthism is all about putting the individual and their choices as the source of illness. It’s very common in fat-friendly and anti-fat spaces alike. When we say it’s okay to be fat if we’re healthy, we’re rejecting fat folk who are not. In healthism, we end up oppressing those living with an illness. We reduce access to supports, we become ableist, and we limit people’s access to well-being.

Living a good life

Seeing health as something to promote in its entirety requires that we change our perspectives about what it means to be healthy, and understand that it is possible to have a good life even if we live with chronic conditions. I believe it’s generally a good idea to engage in behaviours that promote our own health. Go for a walk and touch grass. Drink water. Laugh. Meet with friends who make us feel accepted. Meditate. It’s just as important to have access to a medical system that won’t harm us because of their beliefs around being fat. But it’s also okay to think of  yourself as a beautifully diverse human being who doesn’t need fixing.

If thin people still get sick with many of the things people blame on fat, if health is a privilege that doesn’t last, if well-being is about so much more than physical health… then you don’t need fixing. It is possible to live our best life while being fat. You don’t owe thinness to anyone. You don’t owe health to anyone.

Recommended resources:

• McPhail D., Orsini M. (2021). Fat acceptance as social justice. CMAJ, 193(35), E1398–E1399.
• Health At Every Size (HAES) Principles. Association for Size Diversity and Health (ASDAH).
• Books by Aubrey Gordon (Your Fat Friend)
• Maintenance Phase Podcast – hosted by Aubrey Gordon and Michael Hobbes
• Resources – Lindo Bacon, PhD