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False Dichotomy: Obesity Care vs Body Positivity

We have little patience with false dichotomies. Sometimes they offer a way to win an argument. But they don’t do anything for the cause of finding the truth. When one seems to pop up over and over again, it’s especially annoying. For example, obesity care and body positivity are, in fact, complimentary. Not mutually exclusive. Nonetheless, U.S. News sets them up in opposition to present “the great body acceptance debate.”

Conflict might attract eyeballs and clicks. It might help with ad sales. But manufactured conflicts like this do little to inform us.

“A Battle Over the Perils of Obesity”

Pretty much right from the start, senior editor Joseph Williams winds us up with a false frame. “A battle over the perils of obesity is playing out in pop culture and the medical community,” he writes. He paints the picture of gathering doom, brought on by “extremely obese adolescents” routinely seeking bariatric surgery. So he writes that it’s no wonder that healthcare providers insist that patients must lose weight.

Then he goes on to depict the unreasonable resistance of people who don’t like having shame and blame heaped upon them. Worse yet, the heresy of body positivity is going mainstream, he writes:

The body-positivity movement, once on the fringe, has gone mainstream. After years of slender-only models, New York Fashion Week saw a substantial number of “plus-size” women strutting down the runway.

Note that these ominous “plus-size” women might better be described as smaller than the average American woman.

A Passing Mention of Bias and Stigma

If there is anything constructive in this writing, it’s the acknowledgement that bias and stigma don’t help. Rebecca Puhl explains how common and harmful these attitudes are. They make people sicker.

He also interviews obesity medicine physician Fatima Cody Stanford, who explains the need for respectful care.

Yes, But . . .

In the end, Williams comes back to the false dichotomy. He relies on a trauma surgeon to make his closing point. “Being overweight is a clear health hazard and losing weight is the best option.”

Unfortunately, trauma surgeons are not always obesity experts. And losing weight is not always the best option. Nor is it the only option for someone who is living with obesity. There’s nothing wrong with losing weight. We certainly write about it quite a lot here.

However, losing weight is only a part of dealing with the chronic disease of obesity. It’s not the end of the story. It’s not a cure, nor is it the only thing that good obesity care has to offer. Even after bariatric surgery, people with clinically significant obesity often don’t conform to a fictitious thin “ideal.” Even though their health most often is greatly improved.

One size does not fit all. Weight loss is not always the best answer for improving one’s health. Body positivity is essential for good health. That’s because body positivity means taking good care of the only body you have to love.

Click here for the annoying reporting in U.S. News.

Pick a Side, photograph © Alan Grinberg / flickr

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February 11, 2020

2 Responses to “False Dichotomy: Obesity Care vs Body Positivity”

  1. February 12, 2020 at 5:17 pm, mike said:

    In general definitely agree media sensationalizes issues and often creates simplifed, false dichotomies.

    But here are two thoughts / quesitons Ted:

    1) The issue I think too often by body positive activists is they mix up respect with medical advice. HAES is pretty much wrong from an objective standpoint, because someone with class 3 obesity would undeniably be healthier on average if they instead have a normal bmi of 24. Denying that really APPEARS to be anti-science to many. However, the movement should be closer to being calls RAES – respect at every size. That is inline with bias and stigma being bad (as you rightly mention)

    2) I sometimes read the point about losing weight not being positive, but what metrics, ceteris paribus, would be worse if someone bmi of 35 goes to 30, or 30 goes to 25? Again, this kind of harkens back to my point number 1 above, that the vast body of scientific literature supports the absolute advantage of losing 5 (just as an example) BMI points if everything else stays the same. Surely someone quitting smoking would be beneficial, or someone starting to exercise 3 days a week for 45 minutes, even if their BMI stays at 35 etc. Are there other examples you can think of or have in mind when saying that losing weight is not beneficial?

    After re-reading the article (and deciding if i should post), I think you probably agree with my point 2, you would just instead say that losing weight is just not the only issue a person with obesity has to deal with. And that’s fair enough, its just that I think a lot people have an adverse reaction to minimizing the obvious point that losing weight is almost always beneficial if a person is obese (even though its extremely hard)

    • February 12, 2020 at 5:29 pm, Ted said:

      Mike, the answer to the questions you raise is complicated. Complex problems have complex answers – if they have answers at all. Sometimes they don’t. In general, I agree that I sometimes hear anti-science dogma from some HAES advocates. But I think it’s unfair to paint all such advocates with the same broad brush.

      In answer to your question about an example of a situation where losing weight is not beneficial, I will point you to this rather compelling first-person account: https://nyti.ms/2tFjBhY

      Everyone is different. One size does not fit all. Thinner is not necessarily healthier.