"Health is a cultural construction, not a “fact” that can be defined in terms of science"

[Milkster]

What do we mean by the “health” in the Health At Every Size® paradigm?
Let me be clear: I do not think it’s necessary for all of us who advocate for the HAESSM paradigm to mean the same thing by “health.” I do think, however, that many of us (myself included) have been limiting ourselves and our message by engaging with a limited definition of health, with unfortunate consequences. An unexamined definition of “health” puts us at a higher risk of committing “healthism” in at least two important ways.

The Nature of Healthism
The term “healthism” was first coined in 1980 by sociologist Robert Crawford to describe a “preoccupation with personal health as a primary – often the primary – focus for the definition and achievement of, well-being.” The intervening years have seen only an intensification of this trend, and the term has come to include a moral dimension. These days, we are found morally wanting if we are “unhealthy.” A generation after he first described it, Crawford in 2006 noted how far the healthism meme has evolved, observing that we now tend to use good health as a measure of an individual’s value as a person and a citizen. It has become commonplace to observe that we live in youth-obsessed, thin-obsessed, appearance-obsessed culture; health needs to be included on this list of normative values that we use to measure each others’ worth.
Lest you think I am exaggerating, read this recent blog post (if you have the sanity points to spare). Entitled A Civic Duty to Be Healthy, it’s written by a dietician who asserts that “nobody should consider good health as a purely personal matter that is nobody’s business but his or hers. We all have a civic duty to maintain our health as best as we can and not unnecessarily burden society with the consequences of poor lifestyle choices.” The sorry truth is that this type of rhetoric is all too common. It gets invoked in any discourse around health care reform, health insurance, public health policy, and anywhere else people feel they are entitled to take an interest in other people’s health.
Healthism takes many forms, and we should be worried about all of them. People whose size is perceived as transgressive (whether too fat or too thin) are prime targets of the healthist lens. Fat people who refuse to diet are seen as irresponsible and a burden on their neighbors’ health insurance bill. However, there are two particular forms of this insidious meme that particularly concern me because I think we (and I include myself in this “we”) in the HAES and size acceptance movement unwittingly wield them against ourselves and each other.


#1: The “Perfect Fattie” Syndrome
http://healthateverysizeblog.files.w...pg?w=150&h=112I participated in a panel on healthism at the 2011 ASDAH conference where I showed this slide identifying what some of us call the “Perfect Fattie” phenomenon as a form of healthism. (Click here to see entire presentation.) Some of us fall into the trap of believing that we need to be in perfect health in order to advocate for the HAES principles or equal rights for people of all sizes. This is just plain wrong: none of us has a “duty” to be any healthier than anyone else. Our work is based on human rights (size acceptance) and proven research (HAESSM principles), and that doesn’t change if our health changes. By the way, everyone – whether fat or thin – gets sick, and I hate to be the one to break it to you, but we all die too, so we need to get over it.
Don’t get me wrong. It’s important for us to acknowledge and publicize the fact that many fat people do enjoy excellent physical health and are very fit according to the traditional health indicators. This is powerful anecdotal evidence that the known correlations between “obesity” and various chronic health conditions are just that, and not proof that being fat causes these conditions. The danger is that when one of us declares, “Look at me – I’m fat and I have perfect blood pressure/cholesterol/blood sugar, etc.,” some of the rest of us get worried because we don’t. Does one individual’s health condition change what we know about HAES science? Of course not; my point is that we are all entitled to speak up, whether or not we have health conditions that the medical establishment and the public associate with fatness.


#2: Limiting the Reach of the HAES Approach
We spend a lot of time talking about the fact that it’s healthy habits and lifestyle that matter for health, and not body size or weight. Sound familiar? I have read that in many writings by HAES advocates. I have said it and written it myself. And I am not saying we’re wrong, just that this is an incomplete picture of health.
Emphasizing the evidence that healthy habits and lifestyle rather than weight loss are what have the power to improve everyone’s physical health is an excellent strategy, especially when we are dialoguing with health professionals and others who are caught up in the weight loss paradigm. But by not talking about other aspects of health, we risk alienating many whom we want to reach, namely, the victims of that same paradigm – chronic dieters and disordered eaters, folks who loathe their own bodies, and anyone who has ever been lectured by a health professional to “just eat better” and “just start exercising” in the pursuit of weight loss. And for anyone who has been stigmatized as unhealthy in our healthist society, our emphasis on how to achieve physical health may sound like more of the same.
I am not saying there’s a problem with the HAES principles as defined by ASDAH – far from it. I am actually suggesting that we need to re-read them and especially to take more seriously the second of those principles:

Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects.

When we are faced with the complexity of the human experience in a one-on-one setting, most of us readily apply the above-quoted principle. We see each other and our clients as complex and fascinating human beings with all these dimensions to their experience of health and well-being. But is this recognition reflected in how we talk about HAES issues publicly?


Health as a Cultural Construction
Despite my conviction that we are applying this idea of multi-dimensional health in practice, I don’t often see it reflected in our rhetoric about the HAES approach. It’s not that we never bring it up, but this part of our message too often goes unnoticed or unmentioned. I worry that allowing that to happen is tantamount to engaging in physiological essentialism – talking about health as if physiology is all that matters.
Health is a cultural construction, not a “fact” that can be defined in terms of science. Yes, we are engaged in a debate over the scientific evidence, but there is a deep cultural divide that needs to be bridged as well. If we tacitly accept a concept of health that focuses almost exclusively on physiology, then we may be subtly participating in healthism and supporting the very paradigm that we are seeking to change. Linda Bacon has suggested that the HAES approach is “the new peace movement.” This is a brilliant reframe of the rhetoric of the “war on obesity.” Maybe we need a similar type of reframe around physiological essentialism and the definition of health.
Can we bring a recognition of the multi-dimensional nature of health to our rhetoric without losing our clarity around the physiological evidence that supports a HAES approach? Is there a way to do it without alienating the health care professionals we would like to convince to abandon the weight loss paradigm for a health-based approach? I don’t have all the answers to these questions, but I am going to try to continue to sort them out. I have already started working on another post about some of the other dimensions of health. Meanwhile, I would love to hear what you all think.

http://healthateverysizeblog.org/201...ean-by-health/


Why is HAES and Fat Acceptance so popular now? Why should people feel good about being grossly overweight?

[Tyrath]

What can I say about this, other than that it's wrong?

Although I feel like you're giving HAES more credit than they deserve for being "popular."

[Milkster]

What can I say about this, other than that it's wrong?

Although I feel like you're giving HAES more credit than they deserve for being "popular."

It's extremely infamous and gaining traction. Genetic set point is the new "I'm not fat, I'm big boned."

[kuronosan]

I've already said what I feel about this subject. Obesity is disgusting and is not healthy. People aren't born fat and even if they're born with a predisposition for gaining weight they can easily overcome it with discipline.

Wanting to be unhealthy because you're too lazy to take control is not the same thing as "beautiful".

Being a little overweight myself I can accept the premise that "fat" people are beautiful on the inside. I cannot, however, accept the premise that being "fat" means there's nothing wrong with you. It's simply justification for continuing to live an unhealthy lifestyle because you just lack the willpower to change it.

Next we'll be saying that smoking isn't unhealthy because once you ignore the bad breath, disgusting scent, lung cancer/COPD, chronic addiction, frivolous spending, and increased incidence of death cigarettes aren't so bad.

[Andalusian girls]

when i used to inject heroin directly into my eyeballs my fat friend would say that health is just a cultural construction and not to listen to the prejudiced healthism that told me i was "going to die" at a "very young age"

glad this notion is finally gaining traction

[Mazmaz]

It’s important for us to acknowledge and publicize the fact that many fat people do enjoy excellent physical health and are very fit according to the traditional health indicators. This is powerful anecdotal evidence that the known correlations between “obesity” and various chronic health conditions are just that, and not proof that being fat causes these conditions.

[Ashmada]

Health is a cultural construction, not a “fact” that can be defined in terms of science

But the human body is a mystery!
Science just falls in a hole
When it tries to explain the the nature of the soul.

You know it's woo when it reminds you of a Tim Minchin parody.

Whole text (spoilered for huge):

Spoiler: show

Inner North London, top floor flat
All white walls, white carpet, white cat,
Rice Paper partitions
Modern art and ambition
The host’s a physician,
Lovely bloke, has his own practice
His girlfriend’s an actress
An old mate from home
And they’re always great fun.
So to dinner we’ve come.

The 5th guest is an unknown,
The hosts have just thrown
Us together for a favour
because this girl’s just arrived from Australia
And has moved to North London
And she’s the sister of someone
Or has some connection.

As we make introductions
I’m struck by her beauty
She’s irrefutably fair
With dark eyes and dark hair
But as she sits
I admit I’m a little bit wary
because I notice the tip of the wing of a fairy
Tattooed on that popular area
Just above the derrière
And when she says “I’m Sagittarien”
I confess a pigeonhole starts to form
And is immediately filled with pigeon
When she says her name is Storm.

Chatter is initially bright and light hearted
But it’s not long before Storm gets started:
“You can’t know anything,
Knowledge is merely opinion”
She opines, over her Cabernet Sauvignon
Vis a vis
Some unhippily
Empirical comment by me

“Not a good start” I think
We’re only on pre-dinner drinks
And across the room, my wife
Widens her eyes
Silently begs me, Be Nice
A matrimonial warning
Not worth ignoring
So I resist the urge to ask Storm
Whether knowledge is so loose-weave
Of a morning
When deciding whether to leave
Her apartment by the front door
Or a window on the second floor.

The food is delicious and Storm,
Whilst avoiding all meat
Happily sits and eats
While the good doctor, slightly pissedly
Holds court on some anachronistic aspect of medical history
When Storm suddenly she insists
“But the human body is a mystery!
Science just falls in a hole
When it tries to explain the the nature of the soul.”

My hostess throws me a glance
She, like my wife, knows there’s a chance
That I’ll be off on one of my rants
But my lips are sealed.
I just want to enjoy my meal
And although Storm is starting to get my goat
I have no intention of rocking the boat,
Although it’s becoming a bit of a wrestle
Because - like her meteorological namesake -
Storm has no such concerns for our vessel:

“Pharmaceutical companies are the enemy
They promote drug dependency
At the cost of the natural remedies
That are all our bodies need
They are immoral and driven by greed.
Why take drugs
When herbs can solve it?
Why use chemicals
When homeopathic solvents
Can resolve it?
It’s time we all return-to-live
With natural medical alternatives.”

And try as hard as I like,
A small crack appears
In my diplomacy-dike.
“By definition”, I begin
“Alternative Medicine”, I continue
“Has either not been proved to work,
Or been proved not to work.
You know what they call “alternative medicine”
That’s been proved to work?
Medicine.”

“So you don’t believe
In ANY Natural remedies?”

“On the contrary actually:
Before we came to tea,
I took a natural remedy
Derived from the bark of a willow tree
A painkiller that’s virtually side-effect free
It’s got a weird name,
Darling, what was it again?
Masprin?
Basprin?
Asprin!
Which I paid about a buck for
Down at my local drugstore.

The debate briefly abates
As our hosts collects plates
but as they return with desserts
Storm pertly asserts,

“Shakespeare said it first:
There are more things in heaven and earth
Than exist in your philosophy…
Science is just how we’re trained to look at reality,
It can’t explain love or spirituality.
How does science explain psychics?
Auras; the afterlife; the power of prayer?”

I’m becoming aware
That I’m staring,
I’m like a rabbit suddenly trapped
In the blinding headlights of vacuous crap.
Maybe it’s the Hamlet she just misquothed
Or the eighth glass of wine I just quaffed
But my diplomacy dike groans
And the arsehole held back by its stones
Can be held back no more:

“Look , Storm, I don’t mean to bore you
But there’s no such thing as an aura!
Reading Auras is like reading minds
Or star-signs or tea-leaves or meridian lines
These people aren’t plying a skill,
They are either lying or mentally ill.
Same goes for those who claim to hear God’s demands
And Spiritual healers who think they have magic hands.

By the way,
Why is it OK
For people to pretend they can talk to the dead?
Is it not totally fucked in the head
Lying to some crying woman whose child has died
And telling her you’re in touch with the other side?
That’s just fundamentally sick
Do we need to clarify that there’s no such thing as a psychic?

What, are we fucking 2?
Do we actually think that Horton Heard a Who?
Do we still think that Santa brings us gifts?
That Michael Jackson hasn’t had facelifts?
Are we still so stunned by circus tricks
That we think that the dead would
Wanna talk to pricks
Like John Edwards?

Storm to her credit despite my derision
Keeps firing off clichés with startling precision
Like a sniper using bollocks for ammunition

“You’re so sure of your position
But you’re just closed-minded
I think you’ll find
Your faith in Science and Tests
Is just as blind
As the faith of any fundamentalist”

“Hm that’s a good point, let me think for a bit
Oh wait, my mistake, it’s absolute bullshit.
Science adjusts it’s beliefs based on what’s observed
Faith is the denial of observation so that Belief can be preserved.
If you show me
That, say, homeopathy works,
Then I will change my mind
I’ll spin on a fucking dime
I’ll be embarrassed as hell,
But I will run through the streets yelling
It’s a miracle! Take physics and bin it!
Water has memory!
And while it’s memory of a long lost drop of onion juice is Infinite
It somehow forgets all the poo it’s had in it!

You show me that it works and how it works
And when I’ve recovered from the shock
I will take a compass and carve Fancy That on the side of my cock.”

Everyones just staring at me now,
But I’m pretty pissed and I’ve dug this far down,
So I figure, in for penny, in for a pound:

“Life is full of mystery, yeah
But there are answers out there
And they won’t be found
By people sitting around
Looking serious
And saying isn’t life mysterious?
Let’s sit here and hope
Let’s call up the fucking Pope
Let’s go watch Oprah
Interview Deepak Chopra

If you’re going to watch tele, you should watch Scooby Doo.
That show was so cool
because every time there’s a church with a ghoul
Or a ghost in a school
They looked beneath the mask and what was inside?
The fucking janitor or the dude who runs the waterslide.
Throughout history
Every mystery
Ever solved has turned out to be
Not Magic.

Does the idea that there might be truth
Frighten you?
Does the idea that one afternoon
On Wiki-fucking-pedia might enlighten you
Frighten you?
Does the notion that there may not be a supernatural
So blow your hippy noodle
That you would rather just stand in the fog
Of your inability to Google?

Isn’t this enough?

Just this world?

Just this beautiful, complex
Wonderfully unfathomable, NATURAL world?
How does it so fail to hold our attention
That we have to diminish it with the invention
Of cheap, man-made Myths and Monsters?
If you’re so into Shakespeare
Lend me your ear:
“To gild refined gold, to paint the lily,
To throw perfume on the violet… is just fucking silly”
Or something like that.
Or what about Satchmo?!
I see trees of Green,
Red roses too,
And fine, if you wish to
Glorify Krishna and Vishnu
In a post-colonial, condescending
Bottled-up and labeled kind of way
Then whatever, that’s ok.
But here’s what gives me a hard-on:
I am a tiny, insignificant, ignorant lump of carbon.
I have one life, and it is short
And unimportant…
But thanks to recent scientific advances
I get to live twice as long
As my great great great great uncleses and auntses.
Twice as long to live this life of mine
Twice as long to love this wife of mine
Twice as many years of friends and wine
Of sharing curries and getting shitty
With good-looking hippies
With fairies on their spines
And butterflies on their titties.

And if perchance I have offended
Think but this and all is mended:
We’d as well be 10 minutes back in time,
For all the chance you’ll change your mind.

As for your question, Milkster: because 2 americans out of 3 are (apparently, didn't verify) overweight.
You've reached a tipping point where what was once whale will become normalcy, in time.

[Churchill]

I plan to humiliate fat people every day until my lynching where I become the martyr of meat.

[quannum]

carnival_fat_man.jpg

[Xantavia]

Why is HAES and Fat Acceptance so popular now? Why should people feel good about being grossly overweight?

Why should people feel good about making fun of those who are overweight? Yes, I don't think excuses should be made like "I'm fat because of my genes", but it doesn't come as a surprise to fat people that they are fat. People do get upset when others tell them how they should live their life, so telling somebody you hardly know that they should lose weight most likely pisses them off and sets them in their ways.

[Kalmado]

[miokomioko]

Why should people feel good about being grossly overweight?

It's easier than actually doing something about it. End of story.

[Kalmado]

Why should people feel good about making fun of those who are overweight? Yes, I don't think excuses should be made like "I'm fat because of my genes", but it doesn't come as a surprise to fat people that they are fat. People do get upset when others tell them how they should live their life, so telling somebody you hardly know that they should lose weight most likely pisses them off and sets them in their ways.

I wouldn't go as far to say it to a complete stranger, but someone I know I will not hesitate and I myself am overweight currently. If someone I'm close to is overweight (not just a few lbs) and they're stuffing themselves with double whoppers, Mt. Dew, etc I'm going to say something because I care about their well being.

[Churchill]

[Churchill]

[Xantavia]

I wouldn't go as far to say it to a complete stranger, but someone I know I will not hesitate and I myself am overweight currently. If someone I'm close to is overweight (not just a few lbs) and they're stuffing themselves with double whoppers, Mt. Dew, etc I'm going to say something because I care about their well being.

Family or friends, you can have a tough conversation with them about it. Yelling "Hey fatty" when you see somebody at McDonalds isn't going to do anything. I'm curious how people in gyms react to overweight people who come in interested in trying to get healthier. Do they point and stare, making them feel uncomfortable so they never come back? I'm hoping it is more along the lines of not really paying any attention to them, but my gut reaction says it is the first. This is coming from a biased viewpoint though, equating the guys working out in the gym to being like the jocks in high school, the ones who gave me crap for being fat.

[GoggleHead]

Body shame is a hell of a deterrent. It definitely keeps me from even really considering a gym membership and I'm not really fat, just out of shape. I can only imagine how traumatizing it must be for the real fatties.

[Ashmada]

http://images.sodahead.com/polls/001...pe_xlarge.jpeg

[quannum]

whether they're fat or not, anyone who joins in january needs to gtfo my gym

[Elesirdur]

Forward: I smoke about a pack a week, though consider myself fit and healthy otherwise, so feel free to call me a massive hypocrite for any of the things I'm about to write.

While I don't agree with every word from the linked blog post by the registered dietician, I do agree that being healthy is a civic responsibility; regardless of whether one lives in a country with socialized healthcare (I'm a Canadian) or a private health insurance market. Under socialized or government mandated healthcare programs we encounter two problems that lead to market inefficiency - the free rider problem and a problem of moral hazard, while moral hazard applies only to private health insurance jurisdictions. Both of these apply to any individual who does not take up their public responsibility for maintaining some decent standard of health (perhaps like me with my smoking) but especially to those who engage in behaviour that actively damages their health and lifespan.

The moral hazard is just the above, agents engaging in dangerous or harmful behaviour as they no longer face the true cost of those actions. So since I'm a Canadian I can eat myself stupidly fat, get diabetes and probably Crohn's disease along with some form of heart disease, and not pay a penny more or less in taxes for my behaviour, only being responsible for costs not covered by healthcare. Since I do not bear true cost of my dangerous behaviour, I structural and/or financial reason to stop (abstracting from social issues) I can continue to do so at my own peril. Multiply the likelihood of engaging in dangerous behaviour covered under moral hazard to an entire society, and you end up with the free rider problem. Since I don't directly pay for my actions, I will also likely overuse the system which is provided as a public good. These dangerously compounding factors lead to increases in costs to the health care system, which in turn lead to increased taxation to pay for health services, and increased premiums on ancillary health insurance.

These are two of the primary reasons why governments and public health agencies put effort into keeping people healthy; it's better for the economy when someone is healthy and productive. When persons decide to abrogate their public duty to maintain some standard of good health, they impact everyone in the society. It is a subtle effect, which is why garbage like this "morbidly obese-positive" crap can exist.

Beyond just market inefficiencies, healthy and happy people just tend to live longer and more productive lives (I assume, no data/research on hand to back that up though the results from Harvard's longitudinal Grant study would seem to bear this out) which is just plain good for the economy and society in general. Think of how historical societal progress began a significant upswing as people began living longer. From a point of equality and fairness, we should want everyone in all societies to reap the benefits of a long, happy, and productive life. Ignoring one's health and engaging in behaviour that increases morbidity is to rob not only oneself, but society of the benefits that an individual can provide by, you know, being alive. The compounding problem for people who do not take the steps necessary to ensure a standard of good health (calling out obese persons here) is that not only does life expectancy go down, but past a certain point economic and social utility and productivity rapidly declines and can become a net drag on the economy - how productive is a person whose obesity or diabetes is so bad that they are classified as disabled? Now I know this argument can tend down a slippery slope to all sorts of cruel topics like eugenics, but please be assured that this is not my intention.

"Sources": I'm a graduate student in Economics focusing on public economics and public finance.

tl;dr A decent standard of health should be a civic and public responsibility from an economic productivity standpoint, but also from one of general social welfare and improving the life of a human being.