Our culture perpetuates myriad anti-fat myths and prejudices that keep people depressed and at war with their own bodies: a war where few battles might be “won” in the short term with restrictive diets, but then lost overall because those who turn to dieting can rarely maintain the behaviors and appearance that become socially accepted as “ideal,” or normative. Dieters then feel worse about themselves for their perceived failure. Diet culture reinforces the message that the individuals themselves—not the size-stigmatizing culture—are the problem. The guilt-ridden menu that society hands each fat person has led to a severe case of indigestion! Let’s throw out the bad advice and discuss new truths that will lead to happier, healthier lives in a fairer world. We need your help to spread the word. One of the ways to spread the word is to check out Linda Bacon and Lucy Aphramor’s new book, Body Respect: What Conventional Health Books Get Wrong, Leave Out, or Just Plain Fail to Understand about Weight. We have been gifted with a sneak peek that we’d like to share on this week’s blog.
If you’re familiar with Linda’s groundbreaking book, Health at Every Size, you know that the Health at Every Size® (HAES) movement is all about respect.* It teaches how respecting yourself means learning to treat yourself with kindness, and leads to trusting your body’s signals so you follow your appetite instead of a calorie chart. And if you’ve tried this for yourself, you’ve discovered how this gentle approach to nutrition and self-care can seriously improve your well-being, whatever your shape or size. In the science of nutrition, weight, and disease, HAES- based studies find encouraging evidence that we need not fear food—or fat—as agents of illness and despair. These studies also identify paths toward health that avoid dreaded diets and dieting—those rocky shoals against which so many good health intentions have shipwrecked. HAES principles lead to obvious, inexpensive interventions, available both to individuals and health care practitioners, that can produce better health for anyone, no slimming down or body hatred required. Food restriction and fat are off the hook as far as well-being is concerned—thus moving fat stigma and lack of respect on other grounds into the shameful limelight.
HAES is an entirely hopeful, helpful doctrine. And it belongs not to a single author or set of authors, but to a large and growing cohort of people, lay and professional, who are bound by their mutual desire for respect and equality and by their challenge of commonly held assumptions about fat.
Since Health at Every Size came out, there have been new scientific developments and the HAES movement has evolved, so the two of us, Linda Bacon and Lucy Aphramor—both scientists with PhDs—have teamed up to take a fresh look at the ideas and facts behind HAES, including the latest science on diet, weight, and health. In Body Respect, we provide you with data that back up the HAES claim that you can find peace and gain better health in your body. For health care practitioners, we also raise critical awareness about how to reduce health inequalities, and present new strategies for applying HAES principles more fully to help you support others on that journey. Using peer-reviewed evidence, common sense, and a solid grounding in nutrition science that integrates data from critical public health sources, we debunk obesity myths and guide you through the process of supporting individuals in carving their own paths, knowing that their worth is not in their weight.
Who This Book Is For
First, this book is written for a diverse readership. If you’re directly affected by our culture’s and the medical community’s attitude toward weight and feel uncomfortable in your skin— whatever your size—this book is for you. We don’t pretend that it’s simply a matter of pulling your socks up and improving your self-image; we do consider the reality of ambivalence and conflicted feelings around size acceptance.
Second, the book is also for medical practitioners and students of health and health care so you, too, can understand the reality of what it’s like for someone both society and your medical community regard as “overweight” or “obese”—we actually prefer the term “fat,” and we’ll explain why later in the book— and for others who live in fear of becoming fat. Body Respect helps you understand the damaging ramifications that the “thin is better” mind-set has on people of all sizes and on health inequalities. It makes a persuasive case for a new approach that helps you champion patient dignity and high-quality science. We teach you how to advise people of any size with compassion and body-honoring prescriptions that will guide them toward better health, not toward a certain weight, which will in turn make your job more rewarding. As a guide, at the end of the book you will read about a health care provider, “Billie,” and her patient, “Janet,” and the challenges they face in managing Janet’s diabetes. Billie’s experience, which compares conventional practice with an HAES-based approach, illustrates the positive, transformative promise of HAES when adopted by the medical community.
Third, we want to reach out to policy makers and change agents, people on the front lines of community development and their allies in public health working to reduce health inequalities. Where social differences in access to nutritious foods and the personal circumstances needed to be regularly active have been made all too starkly obvious, it is easier to keep our focus on improving individuals’ ability to adopt more healthful lifestyle habits. Undoubtedly, eating and exercising affect well-being, and not everyone has access to the material means to be active and eat well, so this social inequity needs to be addressed. But these inequities need attention because they are a travesty; challenging inequity is its own justification and should not require a health improvement checklist to legitimate action. That said, lifestyle doesn’t have nearly as much impact on anyone’s health as the anti-obesity brigade would have us believe. In fact, the nonmaterial or social effects of living with deprivation and discrimination account for a huge portion of the social gradient in health—much more than that attributed to health behaviors. Yes, everyone needs access to a standard of living that includes good food and the chance to move. But maintaining the primacy of the individual-lifestyle focus—without being transparent about larger influences—is an affront to people living in disadvantage, as it reduces their ill health to poor “choices” and blames them, all the while contributing to the stigma and judgmental thinking that fuels their oppression, worsens their health, and expands the health divide between the advantaged and disadvantaged.
We’re vocal about size equality as an issue of social justice. It matters that larger people get judged poorly because of their weight, while thinner people are awarded advantages for their size, and these forms of oppression and privilege need to be challenged. We’re against dieting not only because it compromises health (and has actually been proven to cause weight gain in the long term) but also because it feeds weight stigma. We don’t tell people being fat gives you a heart attack, just like we wouldn’t tell someone with yellow teeth that the color of their teeth is going to give them lung cancer. We do ask why the social factors that impact nutrition-sensitive diseases like hypertension and diabetes aren’t more widely publicized. In short, we look at what’s really behind illness and health, and the truth might surprise you. (Hint: It’s not fatness.)
Lifestyle doesn’t have nearly as much impact on anyone’s health as the anti-obesity brigade would have us believe.
We could add that the book is also for a fourth audience, the skeptics. But we imagine that camp has members in all of the other three groups. For those who are having a hard time believing that fat is not the problem, stay with us. We know that you may find this book challenging, even aggravating. Already, we realize, your natural skepticism may be rising to the fore. We all know many people are overweight, you may be insisting, that there’s an obesity crisis underway. How can these authors just give up on getting people to lose weight for their own sake? Or even, How can I, knowing what I know about obesity, in good conscience consider setting all that aside and let people “feel better” about being fat? If they stop caring, won’t their weight and poor eating habits spiral even further out of control?
We ask you to hold those thoughts. Jot your frustrations in the margin, if you must, or dictate an angry memo into your smartphone, but then please read on, because one of the discoveries available to students of HAES—if still unrecognized by too many in the medical and health policy arenas—is that what we think we know about fatness isn’t based on actual fact. Alarmingly, neither is what we think we know about lifestyle and health. That’s why we wrote this book.
If you’ve read the first book and are keen to pass the message on, this lighter volume can galvanize the HAES conversation with friends and colleagues. We all need the support of others, and receiving encouragement begins with others understanding why we believe what we believe. In addition to providing the updated science on weight in a concise way for newer readers, Body Respect expands on the concepts of how stigma and stress impact well-being introduced in Health at Every Size.
Our culture perpetuates the anti-fat myths that keep people depressed and at war with their own bodies: a war where little battles might be won in the short term with a diet, but then lost overall because those who turn to dieting can rarely maintain long term the look that is the accepted norm—one that is not necessarily the best weight for them. And they feel worse about themselves for their failure. It also reinforces the message that they—not the size-stigmatizing culture—are the problem. The guilt-ridden menu that society hands each fat person has led to a severe case of indigestion. Let’s throw out the bad advice and discuss new truths that will lead to happier, healthier lives in a fairer world. We need your help to spread the word.
What we think we know about fatness isn’t based on actual fact.
Our ultimate goal in Body Respect is to champion a paradigm shift—from weight to respect. We examine what weight means to our bodies, how our metabolisms work, and the mechanisms involved, including concepts like “fat” and “calories” that carry so much baggage in our society. We also look at exercise; the science of dieting; biases around fat and bodies, and the impact of prejudice and privilege; and a collection of other cultural factors that affect individuals’ health. Throughout, we consider how dogma, myths, and prejudices about fatness, presented as the value-laden “obesity,” have trumped actual evidence in our society’s evolving views of weight and health.
Relying on fact and sound judgment—and with a passion for fairness and equality—we work in every chapter to separate scientific fact from panicked assumption, unraveling the tangle our culture has made of weight and body shape. From the still-evolving science of modern diet and health, we draw practical lessons and recommendations for effective interventions and policies. We also provide personally applicable, self-help style recommendations that could make a difference in your own life as well as the lives of current or future clients and patients.
Support for You
A warning is in order: If you do get past any initial skepticism about HAES, the next possible hazard is the frustration of dealing with everyone around you who hasn’t. It can be exhausting to believe in a new paradigm, a completely changed view of familiar matters, and to have to defend or explain it again and again to everyone mired in old ways of thinking. HAES advocates are not above critique, nor is its theory set in stone or its strategies unanimously agreed upon.1 It’s critical that the movement be open to the inevitability of flaws, gaps, and new perspectives, including proactively seeking input from marginalized communities. But to be positioned as an ambassador for any cause can be draining. That’s where education and the HAES community come in. There is a large and growing community around HAES and size acceptance, both online and in associations, and at workshops and conventions. And as books and courses on this topic proliferate, workshops emerge, and more clinics adopt HAES ideas, there is hope for more.
In its promise of real, measurable change—albeit change that will never be documented on a scale or with a tape measure—HAES offers a path forward for all who care about respect and health. With this book, we hope to help map the way.
The Books Organization
We start by examining common assumptions about body weight and health and then look at weight regulation in individuals. In the process we deconstruct generally accepted ideas and replace them with a more scientifically supported understanding, commonly called “Health at Every Size.” We then put all the information together to figure out what conclusions can be drawn about the best way to approach self-care (weight, nutritional well-being, activity, and other related issues), and we highlight the pressing need to put social justice center stage in the health conversation.
A Word about Pronouns
We have written this book with three audiences in mind, which means that the authorial voice is not static. We use “you” consistently throughout the book to speak to those readers, fat, thin, or somewhere in between, who feel the personal pain of weight stigma. An aside: For many people this will include internalized stigma and feelings of shame—decades of fat activism, however, have created an alternative.2 Our belief in the power of compassion drives us, and a respect for equality is a constant at the heart of this book.
This book has two authors. We use “we” most of the time because it represents our combined thoughts. When we need to specify one author over the other, we use the author’s name, Linda or Lucy, rather than “I.”
*Health at Every Size is a registered trademark of the Association of Size Diversity and Health and is used with permission.
Jacqui Gingras and Charlotte Cooper, “Down the Rabbit Hole: A Critique of the ® in HAES®,” Journal of Critical Dietetics 1, no. 3 (2012): 2–5.
Charlotte Cooper, “A Queer and Trans Fat Activist Timeline: Queering Fat Activist Nationality and Cultural Imperialism,” Fat Studies: An Interdisciplinary Journal of Body Weight and Society 1, no. 1 (2012): 61.