Recently, Bill Maher said some incredibly inflammatory things about fat people. He asserted that “the problem with our healthcare system is that Americans eat shit and too much of it.” He stated, based on this OPINION PIECE in the New York Times , that “poor diet is the leading cause of mortality in the United States.” The article, which contains gems equating fatness with disease such as “Three in four adults are overweight or obese. More Americans are sick, in other words, than are healthy,” is misleading at best.
The study that this opinion piece cites actually says “Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention.” It further states that,” Ischemic heart disease (IHD); cancer of the trachea, bronchus, and lung; chronic obstructive pulmonary disease; Alzheimer disease and other dementias; and cancer of the colon and rectum were the 5 leading causes of death.” While “obesity”and overeating are risk factors for Ischemic heart disease, so are things like:
- family history of coronary heart disease
- high blood pressure, also known as hypertension
- high cholesterol
- diabetes mellitus
- end-stage kidney disease
- amyloidosis, a condition in which abnormal proteins build up in your tissues and organs, including blood vessels
- sedentary lifestyle
- history of smoking tobacco
- alcohol or drug abuse
Rather than examine the complexities of the information presented in the study, Bill Maher decided to lash out at an already marginalized, ridiculed, and shamed population. “But why do people have so many pre-existing conditions? Being fat isn’t a birth defect. Nobody comes out of the womb needing to buy two seats on the airplane.” He goes on. “Everyone knows “obesity” is linked to terrible conditions like diabetes, heart disease, and virginity.”
The links between being fat, diabetes, and heart disease are there, but are not well understood and don’t prove which causes which. “Excess weight is an established risk factor for type 2 diabetes, yet most obese individuals do not develop type 2 diabetes. Recent studies have identified “links” between obesity and type 2 diabetes involving proinflammatory cytokines (tumor necrosis factor and interleukin-6), insulin resistance, deranged fatty acid metabolism, and cellular processes such as mitochondrial dysfunction and endoplasmic reticulum stress. These interactions are complex, with the relative importance of each unclearly defined.” Not all patients who are fat develop Type 2 Diabetes. Not all people who develop Type 2 Diabetes are fat.
Maher goes on. “There’s literally nothing being overweight does not make worse.” He cites things like eyesight, pain, memory, fatigue, depression, and a weakened immune system without actually offering evidence to support any of these claims. “We scream at congress to find a way to pay for our medical bills but it wouldn’t be nearly the issue it is if people just didn’t eat like assholes who are killing not only themselves but the planet.” He says a lot of other really inaccurate and inflammatory things, but I’d rather get down to the nitty gritty of why this matters.
“Obesity” is complex.
While we all know that overeating is one thing that can contribute to being fat, “The risk factors that contribute to “obesity” can be a complex combination of genetics, socioeconomic factors, metabolic factors and lifestyle choices, among other things. Some endocrine disorders, diseases and medications can also cause weight to increase.” Healthy foods are considerably more expensive than processed foods, genetics play a huge role in whether or not you’re fat, and some medications, particularly psychiatric medications, cause side effects like weight gain, high blood pressure, high cholesterol, or even diabetes. A few years ago, a combination of medications I was on caused me to gain 70 pounds in 2 months.
Fat Shaming DOESN’T work.
According to a 2014 study from the University College London, “Our results show that weight discrimination does not encourage weight loss, and suggest that it may even exacerbate weight gain,” the study’s lead author, Sarah Jackson, said in a statement. “Previous studies have found that people who experience discrimination report comfort eating. Stress responses to discrimination can increase appetite, particularly for unhealthy, energy-dense food.”
Health At Every Size is an approach that every doctor should be familiar with.
I’m very lucky. I have excellent doctors who actually listen to me, evaluate me, and work hard to accurately diagnose me. There are people my size and larger who are not so lucky. There are women who have been told their pain would resolve if they lost weight who actually had undiagnosed cancer. Health At Every Size posits that the war on obesity has been lost and that, rather than shaming people for something that is very difficult if not impossible to sustainably change, doctors should address their own fatphobia and anti-fat bias when it comes to how they practice medicine.
Diets don’t work.
Here are some good places to start if you don’t believe me or if you just want to do more research on your own:
James Corden’s video is a good start, but still has some problems.
“We know that being overweight isn’t good for us, and I’ve struggled my entire life trying to manage my weight and I suck at it… I’ve basically been on and off of diets as long as I can remember and, well, this is how it’s going.”
I’m not going to get into it too much on this post, but Intentional Weight Loss is inherently fatphobic. From Fierce Fattie, “The fat acceptance movement was created so the fat bodies were no longer erased and marginalized and discriminated against. By intentionally losing weight, you are erasing a fat body if you have a fat body, and you are buying into the rhetoric that being thinner means that you are more worthy, more desirable, and a lot of people say, “Well, I’m losing weight to become healthy.” You are also buying into that rhetoric that being thinner means that you are a healthier person, which is not based in science. “
In the words of James Corden, “Fat shaming is just bullying….and bullying only makes the problem worse.”
Want to know more? Virgie Tovar is a great place to start. She has this excellent Tedx Talk:
She wrote this book that changed my life: https://www.amazon.com/You-Have-Right-Remain-Fat/dp/1936932318/ref=sr_1_1?keywords=virgie+tovar&qid=1568654331&s=gateway&sr=8-1
She has a great website with a blog and resources: https://www.virgietovar.com/
Here are some things I’m meaning to read but haven’t got around to quite yet:
And here is a whole great list of books I hope to read many of!