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Size Acceptance



Making the Case for Size Acceptance

As you try to approach weight issues in a new way, you may find yourself fielding questions about how you can be trying to just accept your body size rather than lose weight.  How could you handle the following Frequently Asked Questions? 

 ?

I see fat people eating junk food and buying ice cream, so how can you say they don�t overeat?   

Don�t fat people just lack the will power to keep the weight off?   

What about the studies that showed fat people are more likely to eat for �external� reasons like the time of day or because there�s food in front of them?

 

Key Size Acceptance Points:

Fat People Eat the Same as Thin People

The research shows that fat people don�t eat differently from thin people: 

  • There are fat people who binge, but there are also thin people who binge. 

  • Overall, researchers have had a heck of time trying to find any differences, in overall quantity, or the type or composition of diet.   

  • If anyone, of any size, has an eating disorder they would like to get help with, that is usually treatable.  But the person's weight may or may not change with treatment.   

  • The residue of attitudes and behaviors after dieting/restricting (tendency to binge on the foods which were forbidden on the diet,  tendency to eat when not hungry or past the point of fullness - "dieting detox" as I call it)  is not the same as an eating disorder. 

 

Related arguments: 

Maybe we are like breeds of dogs (setpoint theory).

Can't generalize to healthy fat people (people with problems do not represent the general population). 

Current treatments can cause health problems, e.g., dieters are more likely to binge; weight cyclers are more likely to develop hypertension; as a population, the more we diet, the fatter we get (iatrogenic issue).

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?

I can go along with what you say for plus-size people but isn�t there a really high weight where it is too dangerous not to try to lose weight? 

Don�t fat people just lack the will power to keep the weight off? 

What about the studies that showed fat people are more likely to eat for �external� reasons like the time of day or because there�s food in front of them?

 

Key Size Acceptance Points:

Current treatments can cause health problems, e.g., dieters are more likely to binge; weight cyclers are more likely to develop hypertension; as a population, the more we diet, the fatter we get.

  • The treatments we have been prescribing for fat people may in fact be making their problems worse, and may in fact be causing some of their problems.

  • It turns out that fatness is not the best predictor of binging; rather, dieting/restricting is (see Herman/Polivy).

  • Dieting teaches you how to ignore your internal appetite/satiety cues, undermining the very mechanism that helps people eat normally.

  • In populations where people diet less, even when they are heavier than the "ideal" their health and longevity is better than populations which are dieting more, though it is hard to tell what the causal mechanisms are (because they are likely to suffer less discrimination based on body size which leads people to diet) (see Roseta Study).

  • Healthcare providers are supposed to DO NO HARM.  If their own research says that 95% of the time their intervention will fail, and if it does fail, the person will feel worse (physically and emotionally), then how can they justify it?

 

Related arguments:

No proven treatment to change weight permanently: SHOW ME THE DATA!

We shouldn�t �prescribe� for fat people what we diagnose as eating disordered in thin people

Individual health risks vary

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?

But isn�t being fat unhealthy?

I can go along with what you say for plus-size people but isn�t there a weight where it really is dangerous?

Doesn�t being fat cause people to get depressed?

Wouldn�t it solve the problems fat people face from discrimination if they just lost weight?

Aren�t you being too permissive with fat people?  Isn�t it like trying to �accept� that you�ll always be a smoker?

I know someone who lost 100 pounds by dieting (or weight loss surgery, or exercise) and she feels great.

I know someone who lost 100 pounds by dieting (or weight loss surgery, or exercise) and she kept it off 6 years and she feels great.

All I know is that when I eat less and exercise I lose weight so why can�t fat people?

Don�t fat people just lack the will power to keep the weight off? 

Don�t fat people have problems they should get therapy for?

What can I say if someone is unhappy with their weight and wants to lose weight?

 

Key Size Acceptance Points:

No proven treatment to change weight permanently:  SHOW ME THE DATA!

The 1992 National Institutes of Health (NIH) Technology Conference published a list of recommendations for consumers considering weight loss programs. They were not aware of any programs which could answer these criteria, nor have any programs complied since.  The report states:  "In evaluating a weight loss method or program, one should not be distracted by anectodal 'success' stories or by advertising claims. The information that should be obtained includes:

  • The percentage of all participants who complete it.
  • The percentage of those completing the program who achieve various degrees of weight loss.
  • The proportion of that loss that is maintained at 1,3 and 5 years.
  • The number of participants who experienced negative medical effects as well as their kind and severity."

If we do not have a treatment that works, then what we prescribe is all experimental and should be labelled as such. 

In the few number of people for whom weightloss is maintained, people do not necessarily live longer anyway and there is some evidence they die earlier than people of a higher, stable weight.

If we do not have a treatment that works, it really doesn't make sense to go on blaming the victim.  Why do scientists/clinicians keep doing the same intervention expecting different results?  Say it were somehow true that fat people lacked will power, would it make sense to expect them to diet for the rest of their lives?  The healthcare community's responsibility is to come up with interventions that work that make fat people's lives better. 

 

Related arguments:  

Current treatments can cause health problems
, e.g., dieters are more likely to binge; weight cyclers are more likely to develop hypertension; as a population, the more we diet, the fatter we get (iatrogenic issue).

Fitness is more important than weight

Individual health risks vary

We shouldn�t �prescribe� for fat people what we diagnose as eating disordered in thin people

�Success� is taking care of your body

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?

If we can�t help fat people get thinner then what should I do to help them?

What should I do if someone has lost weight and expects me to compliment her?

What can I say if someone is unhappy with their weight and wants to lose weight?

Key Size Acceptance Points: 

�Success� is taking care of your body

Stop reading someone's "success" from their weight.  How many thin, smoking, sedentary, junk-food-eaters get harrassed about their health?

We don't have a weight loss intervention that works, so how do we help make fat people's lives better?

  • Focus on the day-to-day decisions to get good, tasty fuel and fun physical activity, have friends, express yourself.  These are the elements of a good life no matter what a person's body size.  People of all sizes do it and should be recognized for it.

  • Notice how people are feeling and the quality of their lives rather than their weight.

  • Practice "weight neutrality" - focus on what you would focus on if weight was not an issue (in the culture, or to the person), whether you are a therapist, a friend, a clinician, or family member. 

  • Work to change the discrimination and weight preoccupation in our culture

 

Related arguments:

Fitness is more important than weight

Medical discrimination causes health problems

Social discrimination causes health problems 

We shouldn�t �prescribe� for fat people what we diagnose as eating disordered in thin people

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?

Doesn�t being fat cause people to get depressed? 

Don�t fat people just lack the will power to keep the weight off?   

Don�t fat people have problems they should get therapy for? 

What can I say if someone is unhappy with their weight and wants to lose weight?  

Key Size Acceptance Points:

Fat people do not have more emotional problems than thin people

  • Studies which have tried to find psychological differences in fat populations have failed.

  • The few studies which have found differences are often of clinical populations (people who are self-selected because they already have problems) and are thus not representative of the general fat population.

  • There are no "obese" personality types/traits

  • There are people who have problems with body image who are fat but there is an equal number who are thin - it is not about body size

  • It is remarkable that there is not a higher incidence of depression, etc. because fat people are members of a stigmatized group. We should be studying why they are not depressed, i.e., how they are psychologically resilient.


Related arguments:

Can't generalize to healthy fat people (people with problems do not represent the general population).

Fat People Eat the Same as Thin People

Social discrimination causes health problems

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?

Wouldn�t it solve the problems fat people face from discrimination if they just lost weight? 

Even if fat people maintain a higher body weight and don�t eat more, shouldn�t they eat as little as they need to to be thin?  Maybe they shouldn�t eat like normal people.

What can I say if someone is unhappy with their weight and wants to lose weight?

 

Key Size Acceptance Points:

We shouldn�t �prescribe� for fat people what we diagnose as eating disordered in thin people

If keeping track of everything you eat, having rigid categories of "good" and "bad" foods, not eating in response to body cues, having your mood/feeling of control/"success" depend on the number on the scale, etc., is bad for thin people, why do we recommend it for fat people? 

  • Look at the descriptions of the "maintainance strategies" of the 3% "successful" weight loss maintainers and in many respects it is difficult to distinguish them from the practices and preoccupations of eating disorder patients.

  • Therapists usually challenge the magical thinking associated with weight ("My life will be so much better if I can lose weight") when a thin person displays it, but agree with it when a fat person expresses it.

  • We need to practice "weight neutrality" - looking at people as individuals rather than having their weight dictate our actions.

 

Related arguments:

Maybe we are like breeds of dogs  (setpoint theory).

Medical discrimination causes health problems 

Fat people do not have more emotional problems than thin people

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?

But isn�t being fat unhealthy? 

I can go along with what you say for plus-size people but isn�t there a weight where it really is dangerous?

Key Size Acceptance Points:

Individual health risks vary: The argument about the health risks of obesity is much more controversial than is typically portrayed

  • Correlations are there for certain health problems at higher weights, but let's remember that correlation is not causality. There are also some health advantages to weighing more, including less likelihood of osteoporosis.
  • For any given individual, fat may be a health problem or not. Maybe we're like breeds of dogs. St. Bernards are never going to be greyhounds, even if starve themselves. And maybe they don't live as long, but we seem to be able to let dogs have their breeds and not shoehorn them all into an "ideal" height and weight or BMI chart. If you're a chihauhau who is 5 pounds over your genetic weight, maybe that is health-threatening. If you are a Rottweiler, who can even tell?

Medical discrimination causes health problems

  • More fat people are poor (fat women make the same amount less than thin women as short men vs. tall men), and more of them do not have any medical insurance at all because the insurance companies won't cover them, or charge exorbitant rates to cover them.

  • Research is currently underway to document the avoidance of medical care by fat people who don't believe that they'll be treated for their problems without a weight-loss lecture, so their problems may be more advanced by the time they see a doctor. 

Social discrimination causes health problems

  • The stigma against fat people is profound and stressful, and the same diseases that are associated with being in other oppressed groups (high blood pressure, for example) may be caused by social discrimination. 

  • In the Roseta study, an Italian-American community where fatness was not a bad thing, people had lower incidences of the health problems usually correlated with fatness.

 

Related arguments: 

Current treatments can cause health problems, e.g., dieters are more likely to binge; weight cyclers are more likely to develop hypertension; as a population, the more we diet, the fatter we get (iatrogenic issue).

back to top


?

But isn�t being fat unhealthy? 

If we can�t help fat people get thinner then what should I do to help them? 

What can I say if someone is unhappy with their weight and wants to lose weight?

Key Size Acceptance Points:

Fitness is more important than weight

  • See Steven Blair's work and the other long-term, massive studies from the Cooper aerobics center.  Fat, active men lived longer and were healthier than thin, sedentary men.

  • If we helped people of all sizes integrate more pleasurable physical activity into their lives we would do everyone a favor.

  • By focusing on exercise for weight loss we set people up to give up if they don't become thin.

Related arguments:

Current treatments can cause health problems, e.g., dieters are more likely to binge; weight cyclers are more likely to develop hypertension; as a population, the more we diet, the fatter we get (iatrogenic issue).

No proven treatment to change weight permanently: SHOW ME THE DATA!

�Success� is taking care of your body

back to top


?

Doesn�t being fat cause people to get depressed?

I see fat people eating junk food and buying ice cream, so how can you say they don�t overeat? 

Don�t fat people have problems they should get therapy for?

What about the studies that showed fat people are more likely to eat for �external� reasons like the time of day or because there�s food in front of them?

 

Key Size Acceptance Points:

Can't generalize to healthy fat people (people with problems do not represent the general population).

  • Studies of people seeking help, or examples of people with problems, do not tell you about the general population. The �clinical� population of fat people (those that seek mental health services) is not representative of the general population, just as thin people who seek help are not representative of all thin people.

  • The general population of fat people has no associated personality type or trait, no higher incidence of depression or mental health problems (which is rather extraordinary given the discrimination they face).

Related arguments:

Fat People Eat the Same as Thin People 

Fat people do not have more emotional problems than thin people

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?

Aren�t you being too permissive with fat people?  Isn�t it like trying to �accept� that you�ll always be a smoker? 

I know someone who lost 100 pounds by dieting (or weight loss surgery, or exercise) and she feels great. 

I know someone who lost 100 pounds by dieting (or weight loss surgery, or exercise) and she kept it off 6 years and she feels great.  

All I know is that when I eat less and exercise I lose weight so why can�t fat people? 

Even if fat people maintain a higher body weight and don�t eat more, shouldn�t they eat as little as they need to to be thin?  Maybe they shouldn�t eat like normal people.

What about the studies that say being fat is a killer disease?

Key Size Acceptance Points: 

Maybe we are like breeds of dogs  (setpoint theory).

  • For any given individual, fat may be a health problem or not.

  • Maybe we're like breeds of dogs. St. Bernards are never going to be greyhounds, even if starve themselves. And maybe they don't live as long, but we seem to be able to let dogs have their breeds and not shoehorn them all into an "ideal" height and weight or BMI chart. If you're a chihauhau who is 5 pounds over your genetic weight, maybe that is health-threatening. If you are a Rottweiler, who can even tell?

  • What may be more relevant to health is not someone's absolute weight, but rather their weight relative to their own genetic destiny. This would explain the wide disparity in findings among some studies, a few of which show health problems with very little "overweight" and others which show no major problems for a wide range of weights, or more problems with being too thin.  

 

Related arguments:

Individual health risks vary

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For more detailed information, check the bibliography and professional books and articles.

 

 

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