Welcome BBC Readers!
Welcome to Fierce, Freethinking Fatties!
If you’re new here, then you probably read about us in this BBC news story. You’re also probably wondering why the hell we’re so proud of being fat.
Well, for one, we’re not proud of being fat. We’re proud of being kickass, awesome people who just happen to possess a few more fat cells than most. But what makes us awesome is not that collection of fat cells, but the people behind the fat cells who society neglects in the pursuit of “health.”
By the current, socially-accepted definitions of health, thin=healthy and fat=unhealthy.
We disagree. We believe that health lifestyles=health and unhealthy lifestyles=unhealthy, but even that is subject to the whims of genetics, the social determinants of health and just plain luck.
But lifestyle choices are more than just what we eat and how active we are. People have the choice of whether to smoke or not, drink or not, go tanning every day or not. All of these choices, along with diet and exercise habits, contribute to your overall health matrix. Focusing on any single risk factor is penny wise, pound foolish.
But we understand the desire to address obesity. The media is filled with stories of the ravages of obesity. So, you come here and you want to know how we respond to the health issues associated with obesity.
Behind the scenes in the medical community there is a seismic shift taking place. Dieting has a well-documented history of failure rate, and the repeated attempts to lose that weight, followed by its inevitable regain, is known as weight cycling, the health risks of which broadly accepted (PDF).
Yet physicians continue to recommend weight loss as the “cure” for obesity despite no evidence that long-term weight loss is sustainable for the vast majority of people. Instead, physicians are recommending a modest weight loss of 5-10% of your starting weight. For a 5’7″, 265 pound guy like me with a BMI of 41.5 (aka morbidly obese), that shakes out to a weight loss of 13-26 pounds. At a weight of between 239 and 252, that gives me a BMI of between 37.4 and 39.5, on the cusp of morbid obesity.
I still look fat, but that little bit of weight loss has made a profoundly positive impact on my health. Why? Is it because I have five less pounds of fat cells on my body?
If that weight loss occurred because I transitioned from an energy dense diet and sedentary lifestyle to a diversified, healthy diet and an active lifestyle, then this may effect my weight, but the loss of the weight itself has little to do with the actual health improvements. What matters are the lifestyle changes I have made, which may, or may not, result in a 5-10% weight loss or more or less.
By hyperfocusing on the importance of weight loss, we have done a disservice to the true goal of healthcare: making us healthy. If we follow the evidence — evidence like the decades of work behind Dr. Stephen Blair’s fitness research — we find that weight loss is not necessary to improve one’s health, but lifestyle changes are.
This approach to healthcare has a name: Health At Every Size® (HAES), and it is an evidence-based approach to healthcare that focuses on emphasizing lifestyle changes and deemphasizing one’s weight status.
“But if you don’t look at the scale, how do you know if it works?” This question stems from a weight-based metric of health. In this model, fat is the disease-causing agent and losing fat is the cure. But the propensity of research does not support this model.
In the world of research, the true disease-causing agent is insulin resistance (IR), or the body’s inability to process one’s blood sugar. If left unchecked, IR can ravage the body, triggering a whole host of metabolic disorders that can lead to impaired morbidity and mortality. IR is a greater indicator of risk for heart disease, type 2 diabetes, hypertension and, yes, obesity.
But not all obesity is caused by IR. We also live in a world where poverty and education, medication, chronic stress, lack of sleep and our newly emerging understanding of endocrine disruptors in the environment have all been implicated in rising obesity rates. And you know what else has been implicated? Weight cycling.
That’s right: dieting leads to weight cycling leads to long-term weight gain.
By taking the focus off of weight and putting it where it belongs — onto IR — HAES offers a reasonable alternative for people who are looking to get healthy and who aren’t interested in jumping back on the diet bandwagon.
HAES has three basic tenets.
- Eat a healthy and diverse diet, paying attention to your body’s natural cues of satiety and craving
- Move your body in a way that you enjoy and that is sustainable
- Love your body as it is
Now, before you dismiss me as a crackpot hocking a new diet fad, a similar approach to healthcare has been advocated by none other than Surgeon General of the United States, Regina Benjamin:
And the national media is beginning to take notice, including the National Geographic and MSNBC. And unlike the traditional weight-based focus on healthcare, HAES has a growing catalog of research that positive long-term health outcomes for its adherents, regardless of weight.
But you’re still skeptical. I completely understand, and I, and my fellow bloggers, are always open to questions, comments and criticism, so feel free to challenge us below.
One word of caution, though: we don’t call ourselves Fierce, Freethinking Fatties for nothing. Any abusive or disrespectful comments will be subject to the Asshole Rule. If five people tag you as an asshole, your comment will be deleted. If you have three comments deleted, you have earned yourself a permaban. So, by all means, ask questions, just don’t be a douchebag about it.
Finally, if you want to learn more about HAES, please visited the Association of Size Diversity and Health, a coalition of healthcare professionals who are committed to spreading the word about HAES. There’s even a great blog filled with excellent resources.
And finally, just to quell that nagging feeling that we must be selling something, there’s a book called “Health At Every Size” written by Dr. Linda Bacon (we know, ha ha, bacon), which reintroduced the concept of HAES and has an incredible amount of research and information on how you can incorporate HAES into your life.
Thank you for visiting us today, and if you have a moment, please consider donating to our billboard campaign to combat the effects that the Strong4Life campaign has had on the children of Georgia.
Chief Fatty at Fierce, Freethinking Fatties.