Wednesday, December 9, 2009

HAES Challenged

I don't like fundamentalism of any stripe. When one's ideology gets in the way of evidence-based assessment, you gotta problem in my book. There was a bit of a firestorm last week over a piece written by Lionel Shriver in the UK's Guardian Newspaper in which she details her concerns regarding her brother's obesity. Her brother was very unwell (notice the use of past-tense because he died shortly after the piece was published of cardiac arrest). His obesity was a major factor of his ill-health, though it was not the only factor. He was 330lbs, diabetic, had a compressed spine, high blood-pressure, major bone/joint problems due to an assault and an accident and serious respiratory problems. His weight exacerbated all of these collective health problems.

After detailing his ill-health, she goes on to criticize the Fat Acceptance Movement, especially HAES, Healthy at Every Size. She couches these criticisms in culturally sensitive terms, understanding that:

I have buckets of sympathy for the obese, often subject to cruelty, ridicule, denunciation and contempt. Fatties are the one subgroup you can still make fun of on the BBC and not lose your job. Likewise, I sympathise with their recurrent sense of hopelessness. Dieting is odious and can require years of determination and sacrifice. I entirely understand the impulse to say screw it and have another piece of cake. But the "fat pride community" doesn't want my sympathy. They want acceptance. They want respect.

Respect, yes, for their feelings, for their humanity. But I won't simply accept that my brother is fat. And his only chance at a future is to refuse to accept himself that his weight gain is irrevocable. Nor can I quite put obesity on a par with being black, female or homosexual. While discrimination against heavy people should be illegal (save when fielding, say, job applications to lead tourists up Mount Kilimanjaro), to equate fat with race, gender and sexual orientation is to cast obesity as an unassailable state over which we have no control.

I think that her concerns are valid, particularly when it comes to HAES. Healthy at Every Size is demonstrably not true. Simply look at the images I chose to accompany this post. The first one is the picture of an anorexic woman who is wasted down to bone and sinew. Not only can you count her vertebrae, you could probably see her heart beating out of her back if the image were a video. She is not healthy at that size. If this is true at that end of the spectrum, it is true at the other end as well. I chose the second image, the image of the average looking girl in the mirror (I think she's supposed to be "fat") and the anorexic girl positioned in the real world. The anorexic girl sees fat, I see average, but average is fat according to our thin-obessed media and perhaps our "normal-range" BMI meassurements. She is not healthy, in the real-world view.

There are many aspects of the Fat Acceptance Movement that I like, especially in terms of preventing fat discrimination, particularly in employment and healthcare access. I also think that decoupling obesity from health as the primary indicator is important because it is only a factor, not the sum of a patient's medical history and often times the obese have other conditions overlooked by physicians eager to suggest weight-loss as the solution to everything. So these are good things and I'm on board with that. Also, looking at the BMI, noting studies that support slightly overweight individuals as more healthy than "normal" weight individuals might be helpful to expand "normal." Personally, I'm not trying to be "normal" I just want to be "overweight" not obese. I think I can maintain that.

HAES fundamentalism, however, that would say someone can be healthy at every weight is simply unhelpful. Its also wrong. I think that one of the reasons Ms. Shriver caused such a firestorm was that she was understanding of the HAES movement's political concerns and interests, but she rejected them as a thin person. I'm a fat person, but I'm not self-loathing in my rejection of HAES, I'm evidence-based. I am a very healthy fat person, my blood panels, my blood pressure, my heart, etc. I was on the elliptical the other day and did 2.5 miles in 30 minutes and kept an average heart rate well within a healthy rate. I should be a poster child for the HAES movement by those measures, but guess what? I know that this body--particularly my joints--will not be able to maintain those great stats at my current weight for much longer and I want to be able to exercise, to move and to travel better, so I'm shedding some weight. I'm not dieting per se, but I am dropping some weight because weight does have an affect on what I can do. I'm not trying to say at what weight you can be healthy and still fat, you have to figure that out yourself, but morbid obesity does have health consequences--simple mobility for one.

So HAES fundamentalists, I'm sorry a thin woman pissed you off by writing an impassioned piece about her now late brother. Healthy at Every Size is simply not true, look at the starving girls in this post, look at the man trapped in the house by his weight. These are extremes, yes, but fundamentalists like to overlook the reality of the natural world in favor of ideology. Just with Global Warming Denialism, ignoring facts is to the peril of more than the self--it imperils our ability to have rational conversations with one another.



  1. I personally equate Obesity with Pregancy. Both prevent and restrict your life style while you are in it, but both conditions can be changed. Yet neither will be changed overnight in a healthy way.

    Therefore, I feel that fat people should not be discriminated against because you are basing your opinion based in a moment in time and in 9 months both condtions could be changed drastically.

  2. I think HAES is often misunderstood in this way. Health At Every Size does not mean that every size is healthy for an individual. You site several good examples of just that. What is a healthy weight for one person may not be for another. HAES is weight neutral, not against weight change itself (which happens naturally for all kinds of reasons in response to different practices), but against the pursuit of weight change as a process. HAES means that anyone of any size can care for the body they have and focus on what it is
    that supports their well-being. I would encourage anyone who would like to further explore HAES to visit the Association for Size Diversity and Health website at