Is Fat Acceptance Denialism?

If you’ve read any criticism of Fat Acceptance or Fat Liberation or Health At Every Size, you’ve probably heard the term “denialism” come up. People in these movements are compared to creationists, anti-vaccine activists, or, most frequently, climate change deniers.

Fat Acceptance proponents range from those who think that the link between fat and “obesity-related” diseases is overhyped and not looked at critically enough, to those who flat-out say that fat does not cause any diseases. (One problem with the latter statement is that just as correlation does not prove causation, it doesn’t disprove causation either; saying we don’t know for sure that fat causes* something does not mean that we know for sure it doesn’t cause something.) A good example of the former is Thing #2 from The Fat Nutritionist’s post, Stuff People Assume I Believe vs. Stuff I Actually Believe:

2) That there are no health risks associated with being fat.

Obviously, there are, or, once again, my blog and the entire “obesity epidemic” concept would not exist. However, even though research shows that there are health risks with being fat, especially extremely fat, the research also seems to indicate that 1) we don’t know for certain whether all those risks are caused by a direct physiological mechanism of adipose tissue, 2) that trying to lose weight does not work permanently for most people, 3) even if it did work permanently, we still do not know whether a formerly-fat person would enjoy the same lowered risk as a naturally-thin person, and 4) that “obese” people with good health habits have less risk, even though they are still fat.

Also, having a condition that means you have more health risks doesn’t make you a bad person or an intolerable burden on society. Lots of different categories of people have elevated health risks (like men), but we don’t stigmatize them in the same devastating ways we do fat people.

Another good quote comes from Barry Deutsch/Ampersand at Alas, a Blog:

I don’t think you could fairly say that people like Linda Bacon, Paul Campos, Kate Harding, and myself say “that there’s no link” — although others have caricatured my views that way. A fairer summary of the HAES view on fat and health is that the strength and certainty of the link is vastly exaggerated and oversimplified; that people can be fat and healthy; and that for fat people who want to improve their health, weight-loss diets almost never work, but HAES does.

Probably there are HAES advocates who say there is absolutely no link, full stop — I think I’ve seen people argue that in comments. But it’s cherry-picking to ignore the most sophisticated arguments in favor of the least nuanced.

As for “minimizing the link” — minimized compared to what? Compared to NPR claiming “being even a bit overweight can potentially kill you”? Or the Surgeon General declaring “obesity is a greater threat than terrorism”? Compared to the mainstream, hell yes I’m a minimizer. I hope Amanda is, too.

Kate Harding has a good summary of her thoughts on this in Don’t You Realize Fat is Unhealthy?! The only one of her 10 points you could maybe sorta call denialist is #3; I think there is some evidence (I’m not sure exactly how many studies have been done) that on average (not to be confused with every single individual) fat people exercise less and eat more than thin people. But there are caveats: there are definitely exceptions, even among very fat people; it’s not clear whether there’s a very big difference in eating or exercise, and there are some studies that don’t show any difference; and it’s hard to disentangle cause and effect here: are people fat because they don’t exercise, or do people exercise less because they are fat and there are barriers to them exercising? Or both? Even putting aside the effects of stigma, if someone identifies as fat and they are told that fat people eat more and exercise less than thin people, it may influence them to do just that. (In any case, I don’t think it’s a big deal if fat people eat more than thin people.)

The Well-Rounded Mama is also a good example of a blogger who writes about fat and health (specifically relating to pregnancy, childbirth, and nursing) who talks about complications for which higher BMIs are a risk factor and how to mitigate the risks, as well as pointing out where iatrogenic effects can lead to worse outcomes for high-BMI women (for example, non-evidence-based practices like using a vertical instead of low transverse incision for Caesareans and ideas like soft tissue dystocia), and standing against radical exaggerations of those risks (which are often used as a threat to try to force women to lose weight or to not have a baby).

All of the above are examples of bloggers who simply do not fit the definition of “denialist”. Yes, I see occasional overstatements in FA, but nothing as bad as “obesity is a bigger threat than terrorism!” I also see wording like “a supposed epidemic of ‘obesity'” that leaves unclear whether the author believes that there has been no increase in obesity rates, or believes that the increase is not great enough to apply the word ‘epidemic’, or feels that the word ‘epidemic’ is inappropriate given that obesity is not a disease. And yes, I do see the occasional statement that can fairly be labeled ‘denialism’. But I think it is inaccurate to say that the Fat Acceptance or Fat Liberation movements as a whole are denialist.

*I’m not completely happy with the “causes/doesn’t cause” wording. “Contributes to” might be better. “Causes” gives people the impression that if that factor (fat) is there, X will happen, and if it’s not there, then it won’t. In reality, several factors might need to be present (e.g. genes that predispose us to a certain disease, stress, working a desk job) before X occurs. As Sannanina explains in comments here, even known carcinogens will not always lead to cancer, and some people who were not exposed to the carcinogen will still develop the cancers associated with that carcinogen.

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23 Responses to Is Fat Acceptance Denialism?

  1. Pingback: Things To Read « Living ~400lbs

  2. Anna says:

    I’d say Ragen Chastain to me is the closest to denialist that I’ve come across. That may not be her personal stance, but it’s how her arguments come across to me, and it looks from the comments that a lot of her readers feel the same. I feel like her ‘correlation not causation’ argument needs to be presented with more explanation, and that as it stands it usually comes across as if she means either that fat doesn’t cause ill health, or that no one’s proved it, when in fact there are a lot of perfectly acceptable studies showing that obesity is likely to contribute to certain problems. Likely, not certain; contribute to, not cause, or make happen 100% of the time. By dismissing those subtleties as just ‘well they haven’t shown it’s causation so it doesn’t count’ is a bit ridiculous, and I feel like the comments on her blog generally illustrate how little her readers have understood the argument. Eg. people talking about certain foods being healthy or smoking being unhealthy when in reality any studies proving those things are only showing correlation, not causation, so by the logic they seem to be accepting about the relationship between fat and ill health , they don’t show anything at all.

    • I pretty much agree with that. Ragen doesn’t say anything that isn’t technically true, and I wouldn’t say that “denialist” quite fits her, but she does lean very heavily on “correlation is not causation”.

      That said, it’s her blog, its focus is not on science, and it’s probably good to have a few blogs like that out there with no pretensions to balance or careful, measured statements to balance out the Obesity Panic rhetoric.

      • Anna says:

        Yeah, I agree with that. I suppose calling her anything which reflects a scientific position is to define her position by something that isn’t the main focus of her work. She does disentangle the health stuff really well from the rights stuff. I like that her science stuff normally has a disclaimer that it doesn’t matter whether it’s healthy or not as far as rights are concerned, which definitely needs to be pointed out as much as possible.

    • KellyK says:

      I don’t know, her point seems largely to be that even *if* fat causes ill health, no one has identified a reliable way to turn fat people into thin people or shown that a constantly-dieting now-thin person is healthier than that same person would’ve been if they’d stayed fat. Unless someone has identified a reliable way to make fat people thin, or to keep people who are genetically prone to fat from becoming fat, without putting them at more risk than the fat did in the first place, then what fat may or may not cause is kind of a moot point from the perspective of an individual’s health, isn’t it?

      She’s also posted, and I’d like to see the study, that in cultures where there isn’t fat stigma, a lot of the negative health effects of being fat disappear. If that’s the case (don’t know if it is, haven’t seen the study), it suggests that a lot of things attributed to fat may be caused by things like severe stress or crappy medical treatment. And we do know, in general, that stress and poor medical care lead to ill health. Do studies showing that fat can contribute to X problem control for those factors, in general? (I mean, you can’t really control for fat stigma and still actually study fat people, but I would think you could use general measures of stress, mental & emotional health, etc.)

      In my (admittedly, English major non-scientist) understanding, the difference between correlation and causation is that a mechanism for how the cause actually happens has been identified (not just hypothesized but actually show to occur). For smoking, we know how toxins in cigarette smoke affect cells and lead to cancer, right? We figured this out because of correlation, but we know what the mechanism actually is. And there’s a difference between seeing a correlation and assuming a mechanism and actually verifying it. Are the methods by which fat contributes to a given illness proven, or just assumed?

      • Yeah, I haven’t seen that study of health effects of fat w/o stigma either and would like to. If they want to do any more studies like that, they’d better hurry up, because cultural imperialism marches on! I don’t think that there’s a good way to control for fat stigma; any place that’s different enough from a fat-stigma-having place to not have fat stigma would have so many other differences that you couldn’t be sure what was causing any difference in health and longevity. (Studies of places without fat stigma would show how healthy fat people in that place were compared to thin people, but couldn’t effectively compare people in that place with people in another place because there would be too many other differences for us to be confident that the difference was due to lack of fat stigma–so we could draw some conclusions from them, but they wouldn’t be “controlling for” fat stigma.)

        Well, in humans, anyway. If we assume that fat doesn’t cause stigma in animals, we can look at animals and see how their health or lifespan is affected, but fat doesn’t affect all animals’ health in the same way (off the top of my head, veterinarians have told me that it’s worse for dogs than cats to be fat), so there is a limit to how much animal models can tell us about how fat affects human health. And then you also have to look at how the animals you’re studying are made to be fat–do they give them a vastly different diet and no access to a running wheel? Do they pick mice that are leptin insensitive? Are results from a mouse confined to a small cage by itself with nothing to do but eat and sleep all day applicable to a fat person with an active social life who works at a warehouse, a grocery store, a daycare, or as a hotel maid (non-sedentary job) and doesn’t do much boredom eating? (Here’s a blog post!)

        I definitely believe that stress and, in particular, low status affects health and is responsible for at least some of the health effects attributed to fat. It’s hard to know how much. I wrote about that here if you’d like to read another post about it.

        I haven’t studied smoking in depth, but my understanding is that we hadn’t technically proven that smoking causes lung cancer in humans, either. We have a lot of correlation evidence that smoking causes deaths, and we can expose cells in a petri dish to carcinogens in tobacco and see that they damage the cells’ DNA, and we can show that exposure to tobacco smoke in mice causes excess mortality, so we’ve got pretty strong evidence, but we can’t do a study where we take human babies at random and assign some to become smokers and some not.

      • Anna says:

        This is the thing that bothers me about the correlation vs causation thing, though. Ragen hasn’t defined what she understands by causation. You can’t identify a mechanism by which something ’causes’ something. You can just identify a ‘lower level’ correlation. Plus, people have claimed to understand the mechanisms by which fat makes people unhealthy. It puts pressure on joints, it makes it harder for the heart to pump blood round the body (since the body is bigger and the arteries are more likely to be clogged). But what tells us that putting pressure on joints damages them? Correlation. No matter how far down you go, all you get is correlation. Hume made this point a damn long time ago but apparently it hasn’t reached Ragen yet.

  3. Anna says:

    Basically, it’s not possible to prove causation, conceptually. Read Hume, read some philosophy of science. It’s not possible. So rubbishing an argument because it’s based on correlation rules out science as a subject.

    • Michelle says:

      That may be so, and I’m not that well-read in philosophy to really comment on it or expand that argument, but it is an important one. But I also want to point out that a lot of the problem FA writers have with “correlation arguments” is not that correlations are, in and of themselves, meaningless, but that they are often PRESENTED quite openly, usually by the media, but sometimes by researchers themselves in the discussion sections of their papers, or even by the PR dept. of the university or organization that supported or published the research, as “causation arguments,” knowing full-well that the average reader will pick up on the implied causation and run with it, without any consideration of confounders. This happens a lot in epidemiology in general, but it seems even more common, and even less questioned, in obesity-related epidemiology and other obesity research.

      • Yes. I ran into an example of this while I was trying to look up something else, where a researcher found that the fat people in her study tended to eat less frequently but more total calories than the thin people in her study, and the media reporting tended to imply that eating less frequently was part of the reason they were fat, even though this was as far as I could tell the first study that had even uncovered the correlation.

    • Joe says:

      As far as public health is concerned, “causation” is not understood in the metaphysical sense. A double-blind placebo controlled randomized trial is a pretty good way to show causation. Such study is impossible in obesity, though, because you can’t randomly assign people to a fat group.

  4. If you guys want to talk about correlations vs. causation, please focus on the arguments, not on particular bloggers from here on out. I’m worried about this turning into a “let’s trash Ragen” party. If anyone wants to bring up additional example that they think are denialism, they can say where they’ve heard them, but let’s keep the attacks to the arguments themselves.

    • Anna says:

      Oh no! I don’t want it to seem like that (I know I”m a bit late to check back here, but still…) I wanted to say that I think Ragen is amazing. I really like her blog and she’s a super-impressive speaker. I just really strongly disagree with the way she presents the correlation not causation thing, but generally think her blog is fantastic.

      • Understood. It can be hard to get nuance across when you’re criticizing someone, and I definitely run into the problem of sounding like I hate someone/something when I really have just one or two criticisms…

  5. I don’t buy the weight loss doesn’t work so we should just give up excuse. And yes I admit most of their techniques are DOOMED FOR FAILURE. Does that mean there is no real help or cure in the future? No kidney patient is told well, we aren’t going to study kidney disease because we can’t do anything for you. What a cop-out. Go read my blog about being 500lbs and try and tell me with a straight face HAES style that fat does not affect health.

    http://fivehundredpoundpeeps.blogspot.com/search?q=size+acceptance

    I think it is a denialist movement. MOST DEFINITELY.

    Sure there are fat and healthy people. Remember I never have denied this.

    One main theme of my blog is about this very issue.

    People know for a FACT past a certain weight the health crumbles.

    IS HAES A WHITE FLAG.

    yes…..

    http://fivehundredpoundpeeps.blogspot.com/2012/06/is-haes-white-flag.html

    • I don’t buy the weight loss doesn’t work so we should just give up excuse. And yes I admit most of their techniques are DOOMED FOR FAILURE.

      It’s not an “excuse”, it’s a rational response to the fact that it’s, as you put it, “DOOMED FOR FAILURE”.

      I actually did read that last post you linked to (“Is HAES a White Flag”) before I even wrote this one; I believe you’d linked to it at living400lb’s blog. But no, I’m not going to read every post you’ve ever written on HAES, especially when you basically phrased it as an order.

      I’m not asking you to deny your reality that you can’t be fat and healthy, but I don’t think we should throw away HAES because it doesn’t work for every single person, when there are a lot of people it does help. I know that you’re hoping for an effective way to modify weight in the future, but the fact is that right now it does not exist, and recognizing that reality is not making an “excuse”.

  6. IF HAES admitted it was not applicable to EVERY person, then hey, I could accept that.
    Admit they are for the midsized, healthy and mobile fat person who can still work, walk and breathe.

    • The thing is, while a cure for fat would be preferable for people whose fat keeps them from being able to walk, that cure does not exist. I think that HAES can still offer some things even for people whose quality of life is affected by their weight. (I don’t know if it’s the best choice for everyone in that situation, but for some it may be.) But in that case HAES is more “the least bad option” than a good option. I don’t think any sensible person would say that HAES can cure everyone’s health problems (whether they’re attributed to fat or not), just that it’s a better approach than weight loss dieting/weight loss surgery. I think it’s more about doing what you can to improve your health without focusing on weight, not about claiming that it will cure everyone’s every health problem.

  7. tguven says:

    When they said that obesity was a bigger threat than terrorism, I suddenly had a vision of very fat people spontaneously exploding, a la Monsieur Creosote. Some people apparently need so very badly to get a grip

    • violetyoshi says:

      I have to admit, even though I believe in fat activism, Monseieur Creoste makes me lol. It’s hard not to laugh at a guy who exploded, and has his heart dangling and swinging to and fro, it’s just so ridiculous.

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