the HAES files: when health speech is hate speech

by Health At Every Size® Blog

by Deb Burgard, PhD

Can you support people’s health while rejecting their bodies? 

The public health authorities seem to think so.  Calls for the “prevention and elimination” of “obesity” are coming at us at unprecedented rates.  Fatness – that is, fat people – are being blamed for just about everything vexing about modern life.  Even the public health programs that acknowledge weight stigma don’t acknowledge their own stigmatizing messages.  Fat people are told to solve the problem of weight bias, bullying, discrimination, and violence by disappearing.

And many fat people are trying to disappear.  In fact, people of all sizes are trying to disappear.  The quest for a body that can disappear – disappear from the view of the stigmatizers – fuels a $60 billion weight loss industry.  Americans are spending more money every year on trying to disappear than we spend on college.  It must be pretty damned important to us.

But no, the public health authorities protest, we are not trying to get rid of you, we are trying to get rid of your disease.  You know, your FAT.

Ah, but there is the problem, isn’t it?  Because fat is not a germ, fat is not a tumor, fat is not a parasite.  Fat is an intrinsic and essential part of our human bodies. 

But no, the public health authorities protest, we are not trying to get rid of all of your fat, just the “too muchness.”

Ah, but there is another problem, isn’t it? Because we can’t decide how much is too much.  The public health authorities can decide on an arbitrary BMI, but it fails to predict who will be sick or well.  It fails to predict longevity.  It even fails to predict how much fat tissue someone has. 

But no, the public health authorities protest, it’s fine then to just try to minimize it.

Ah, but there is another problem, isn’t it? Because people who are trying to minimize their fat are actually dying.  Their treatment is so expensive that insurers try every tactic not to pay for it.  So there really is a “too little” fat problem that begs the question, how much is the right amount?  When there are people sick and dying of “too little” and “too much” fat at a wide range of weights, maybe there isn’t a global “right amount” of weight.  Maybe it is an individual thing, inherited by each of us from our ancestors who survived a dazzling range of environmental challenges.  Maybe we are supposed to be a diverse range of sizes!

BMI is clearly a terrible proxy for health, but is there an “ideal” BMI that keeps a person safe from weight stigma?   How much is the right amount of disappearing  to keep from being a target of hate?  How much of you has to disappear to qualify for insurance without being forced to participate in Weight Watchers at work?  To keep you from being called a fatty during “Childhood Obesity Awareness Month”?  To prevent a weight loss lecture when you go in to see your doctor for a strep throat?  To keep you from being the one the other kids blame because there are no more cupcakes allowed at school?  How much of you has to disappear to make sure you can get a knee replacement without having to first mutilate your stomach?  To keep your school from sending your parents a failing “BMI report card”?  To keep you from worrying that the state will remove your children from your custody?  

Disappearing is the road to death, not health.  But it can seem like a good idea when your body is a target for the haters.  And it is particularly difficult to untangle when the haters claim to be asking you to disappear “for your health.”  Not only do people feel the hate, they feel the prohibition on naming it as hate, because it is delivered in the guise of something that is supposed to be good.

Let us remember that we do not talk about “having” fat, we talk about “being” fat.  We identify with our bodies, even more than our homes or cars or jobs.  When there is a rejection of our bodies, we experience it as the most profound rejection, because we understand that no matter how much weight we lose or plastic surgery we get, we still identify with those original body images.  Even weight loss surgery does not reliably make fat people thin people (rather than temporarily-less-fat people), and even while people are thinner they realize they are the same person as before. Listen to the language of the makeover and you hear the relentless drumbeat of, “I am a whole new person!” because in fact, makeovers are fairy tales and we all understand that.  “I disappeared myself!” is a fairy tale, not a solution.  Disappearing is a death – in fact, a murder. 

It is critical for the public health authorities to understand this psychological truth.  When you hate fat, you hate a part of a person that they identify with.  As a fat person, it is impossible not to perceive the hate in these messages.  It is not a health-promoting sentiment.  It is a violence that is being done, not just to fat people, but to anyone who has a part of themselves that identifies with fatness. That’s pretty much everyone these days, since fat is loaded with meaning in our culture. 

Fat is supposed to represent being ugly, needy, out of control, depressed, vulnerable and so on. Our culture teaches us to relegate these all-too-human feelings to the shadows of our psyches, to strive to be everything that “fat” is not.  So people work very hard at not being “fat” –  all those virtuous meals and workouts and sacrifices are designed to hold the things we fear at bay.  But of course even if today you do not feel ugly, needy, out of control, depressed, and so on, there is still the lurking threat of those feelings emerging tomorrow.  And here is the kicker: You are very likely to feel one of those feelings if someone stigmatizes you.  You are very likely to “feel fat” if someone rejects or shames you.

 So the cycle continues – people being mean to other people, who translate the meanness into a problem with their bodies and blame their bodies.  The problem, people, is meanness.  The problem is hate.

 If you are a public health authority, you have power and you have responsibility.  Even if it is the norm for all of us to hate and fear the feelings that are associated with fatness, even if it is the norm to feel pride in a thin body, you need more insight into your own professional and personal beliefs and how they are organized by the cultural and economic forces of your time.  You need to understand these beliefs so you will do no harm.

I ask you to stop running from or attacking what you fear.  Listen to your public health messages with the ears of your fat loved ones and colleagues.  Let them help you to understand how it feels to be hated and threatened.   Can you really believe this is healthy for anyone?  When you stop trying to make fat people disappear, you might be able to actually have a wonderful conversation about health.

The Health at Every Size® model teases out the hate speech from the health speech.  It protests asking people to disappear in the name of “health.”   It asserts that people become healthier when they stop living in fear, when they have environments free of hatred, when they can use the energy that was going into the effort to disappear to instead care for the body they were taught to starve, imprison, surgically restrict, or run into the ground.  It asserts that people become healthier when they SHOW UP.

 It is time for us all to refuse to disappear.  Refuse the path of death.  Care about, and care for, those who have felt rejected, inside you and outside of you.  At any size, at every size, we are worthy.  May we all SHOW UP and take our place at the table.

13 Responses to “the HAES files: when health speech is hate speech”

  1. Briliant Post that says it all really.

  2. I think there is a common ground that can hopefully eventually be met regarding fat people and anti-obesity crusaders. I’m reading a lot of things on both parts that are actually in agreement but both sides for some reason don’t recognize it.

    • Hi Ashley,

      I am interested for you to say more about this. I can’t speak for “Fat People,” of course, but many of us who have been advocating Health at Every Size practices are in favor of many of the actual programs advocated in the name of “obesity prevention,” like more physical activity opportunities, fewer food deserts, etc., but we consider them interventions for the common good, for people of all sizes, and can’t see how singling out fat people for “elimination” is necessary for them to be implemented. Is this what you mean by common ground?

      There just isn’t going to be “common ground” on the subject of “preventing” or “eliminating” us.


      • Very thought provoking set of posts. I love the blog “Dances with Fat” b/c of Regan’s bravery and her ability to call out so many issues related to size hate. Deb you are right that our culture is steeped in ridiculous messages. In my practice I see women and men of many sizes, most have eating disorders, but even people who do not have eating disorders, sent to me by their doctors to lose weight , are afflicted by self loathing about their bodies. It is so sad.
        I endorse programs that are helpful to all humans in staying healthy and so far we don’t have many of those programs…I am talking about things that help people spend less time in their cars, that subsidize healthier foods, that help people understand how their own appetities are rudely manipulated by advertising, the food we do subsidize and the giant food industry. We are awash in highly palatable invented foods…it is all about money. Then the insurance companies have the gall to tell us to be a certain size or pay more for insurance and go to Weight Watchers . It is all abbout the money.

  3. I love this! This sums up the difficult feelings so well.

  4. I don’t believe that everyone who advocates healthy living and fat loss blames the people themselves who are overweight. Personally, I blame a system that has allowed for severe changes to our normal diet (additives, excessive hidden sweeteners and bad advice in general). The public trusts organizations who are advising people with confusing and conflicting information, while big Agra keeps filling us with corn, soy and their byproducts.

  5. Thank you for this. I’m dealing with a new doctor right now who assumed I must have had a heart attack when I came to her concerned about several weeks of extreme fatigue–even though she asked about my specific symptoms and none of them were heart-related, I have no history of heart disease, and I have no risk factors for heart disease aside from my weight.

    Thankfully, when I pointed this out to her, she agreed (grudgingly) that it didn’t really sound like I’d had a heart attack. If I hadn’t stood up to her and questioned her, I would have been given an unnecessary stress test. Which raises the question: how much of the waste in our medical system comes from fat people being given unnecessary tests that could have been avoided if their doctors had just listened?

  6. I like your graph! In reality, some people don’t buy clothing one size higher until they need clothing that’s two sizes higher. The number on the label means a great deal to them.
    What is more likely to happen is that all people will become obese by 2050 because obesity will be defined as having a BMI greater than 12.
    Many fat people are the biggest fat haters around. Sad but true. They look at their fat with all the fondness with which they might gaze at a malignant tumor.
    Ashley, I think that many times what appears to be common ground is a facade. In other words, doing healthy things doesn’t count unless one gets thin from them. Otherwise, why would Ragen at DancesWithFat who is an award-winning dancer get so much hate mail? Why would Kelly Gneiting’s achievement (he weighs 400 pounds and has completed a marathon) get pooh-poohed by so many?

  7. LOVED these phrases:

    “Listen to your health messages with the ears of a fat person.”


    “Tease out the hate speech from the health speech.”


  8. Interesting post, but I think it would be helpful to point out and deal with the reality that the reason “fat” is such an issue rests upon three pillars that still seem to be largely under-addressed by people (despite that there are reams of information available to educate):

    – Fat is a normal presence in a healthy body. Excess presence of fat is not.

    – Fat is introduced to the body by the combination of uninformed and/or unhealthy eating habits and no, low, or inconsistent activity.

    – Fat can be reduced healthily, but it is something that requires time, conscious rehabituation, and sincere discipline to affect.

    I realize that last one pokes what has become a sore spot for many battling with fat because there is a cultural penchant for assuming that anyone who has excess fat “obviously” either has not devoted the time, does not engage in conscious rehabituation, or lacks sincerity and/or discipline. It remains that the point is intended to speak to the reality of what is required, not to engage the sad state of our culture in regards to it.

    At the end of the day, the opinions of others (any others) affect precisely as deeper or as long or as well as we allow them. Those who are outside our heads, outside our experience, they have no knowledge from which to speak, period.

    While it is true that many outlets, public health included, often overlook or ignore the cultural and psychological weight of their pronouncements, it is equally true that none of these have an obligation to do otherwise. (I say this because expending the energy on being annoyed, angry, hurt, or upset with them is both to continue to grant them more power than they deserve as well as diffuse one’s budget of energy and power to fuel more helpful, healthy pursuits — such as becoming healthy.)

    I take the point of your post and will not deny that it is quite valid from the perspective of one who is externally referenced and for whom the opinions and thoughts of others carry much weight (cough)… it remains that perhaps the better and more beneficial discussion would begin with examining why the utterances of those who have no vested interest in your health except as a springboard to launch their own status or superiority should receive ANY of your energy or focus.

    As someone who has been on both sides of this particular coin (maximum weight = 375lbs), I can tell you that it was a struggle for me to truly empower myself by disempowering the world at large from having this effect upon me. But, to this day, I count it as the most beneficial, helpful, and liberating thing I have accomplished.

    As trite as it may sound, you DO have the capacity to control and determine who received the gift of being able to matter to you.

    Choose wisely, particularly in this arena, because, as we know, it affects your very life.

    • beautifully written.

    • I don’t fundamentally agree with any of this.

      You said:

      1) Fat is a normal presence in a healthy body. Excess presence of fat is not.

      This is tautological, and as such , not useful. Excess or insufficiency of just about anything is not normal. But Dr. Burgard is asking where the dividing line is. I’m sure we can all define an extreme amount, although we probably wouldn’t put it at the same spot.

      2) Fat is introduced to the body by the combination of uninformed and/or unhealthy eating habits and no, low, or inconsistent activity.

      Way to insult most fat people. It also assumes we’re getting stupider as we get older, since it’s well known that the middle-aged tend to be fatter than the young. You may as well say that fat is introduced into the body by people who are smart enough not to starve themselves. It makes just as little sense.

      3) Fat can be reduced healthily, but it is something that requires time, conscious rehabituation, and sincere discipline to affect.

      You’re not saying by how much, though. Or even whether it’s necessarily a good idea. But it certainly is a way to show off how virtuous one is, isn’t it?

      I realize that last one pokes what has become a sore spot for many battling with fat [etc.]

      I’m not battling with fat. I’m fat myself. I’d rather save the energy to battle with people who try to battle with my fat.

      At the end of the day, the opinions of others (any others) affect precisely as deeper or as long or as well as we allow them.

      This I especially don’t agree with – it’s an extremely rare ability for this to be so. Since we’re not generally hermits, the opinions of others do affect us whether we want them to or not. It starts when we are young, and the opinions of our parents not only affect us; we swallow them up as we are genetically wired to do. We deal with individuals and society later on, and in order to learn how, we have to be affected by opinions. We are best affected when we don’t even realize it’s happening – do you know anyone who admits to caring about television commercials?


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