The Worst Impact of Anti-Fat Strategy Isn’t ‘Unhealthy Behaviours’ It’s Early Death and Suffering

UK news is that BMI-based healthcare has been formally recognised as harmful. Wowee. That’s great.

This questioning happened off the back of a report called Changing the perfect picture: an inquiry into body image.” Well, more accurately, it’s off the back of the courage and pain and scholarship and tenacity of all the fat folk and their allies who first spoke up. Those who had the nerve to risk the costly pushback that comes from challenging entrenched ideas and medical authority. Those who survived. Those who dared.

In Changing the Perfect Picture authors say the government’s anti-fatness strategy “is at best ineffective and at worst perpetuating unhealthy behaviours.”

Let’s stop here. Because seriously, WTF.

For sure, we need to scrap BMI-based healthcare.

But we need to replace it with liberation, not another variant of healthism.

Theory matters. It’s not a game. Lives are at stake. Oppression will continue so as long as we let it glide by unchecked, as is happening here.

What the phrase misses is that anti-fat sentiment is never neutral. It is always harmful. Right now in the UK (and elsewhere) fat people die early deaths because of missed diagnoses and maltreatment. Choosing to call the strategy behind this ‘ineffective’ pretends that anti-fatness in healthcare could be benign. It can’t. This is white duplicity.

The phrase fails to acknowledge the abiding consequences of fat oppression in and out of healthcare. As if fat people’s experiences don’t matter so much. When they do.

Second, categorising ‘unhealthy behaviours’ as the worst collateral damage imaginable embeds healthism. Of course fat (and all) stigma impacts people’s behaviours, maybe including eating and movement. Don’t make that the main point. The point is even if it didn’t it would still be wrong.

Oppression is a human dignity and rights issue. It doesn’t need healthism to make the harms valid.

Lamenting ‘unhealthy behaviours’ cements a healthist narrative, one that distracts us from the awareness that living with oppression means fat people’s vitality and wellbeing are impacted, period. Stigma exerts metabolic, spiritual, emotional, and other harm through non-behavioural pathways. Like how acute stress elevates blood pressure, only forever. The destructive ‘unhealthy behaviour’ here is the oppressors’ thoughtless oratory, not the fat person’s meal choice.

Healthism is never a step in the direction of liberation. Neither is erasing fat reality. At best these are toxic and oppressive at worst toxic and oppressive.

Anti-fatness emerges from and perpetutates white supremacy. That’s key to understanding and undoing it.

We need to be really really troubled by the fact that experts who mean to do well by fat people, and reduce body alienation, have invested their passion, and research monies and writing energies to come up with a report like this. One that embeds the healthism it denounces. Presumably this gives us a flavour of their suggested replacement, HAES. In which case, an entirely new option is needed.

That’s not far fetched. For sure, when commenting on the report HAES medics have reminded us that there is a long way to go in real life to get free of BMI. Too true. But the healthism and white supremacy? No comment. Zilch. Zero.

No suggestion that an analysis that suggests anti-fatness policy “is at best ineffective and at worst perpetuating unhealthy behaviours” is a problem, not a remedy. In fact the phrase is singled out for applause, heralded as a ‘breath of fresh air’. Fat affect simply doesn’t exist. No-one is left any the wiser about the ways colonial thinking shapes western science.

There are many more reasons why ‘Changing the Perfect Picture’ is not a fitting tribute to the radical thinkers who brought change this far and whose mantle we carry.

White supremacy is the root causes of them all.

Yes, drop BMI-based healthcare for safer, more reliable proxies; use effective, anti-oppressive approaches. Yes, we need to stop slamming the door in fat (and all) people’s faces in the name of health, or anything else. Also, we need to get clear in our thinking so we don’t agree to stabbing people in the back instead.

Now is the time to educate ourselves on the root cause of health injustice — white supremacy — and demand better.

Here’s some books and writing by fat people:

Roxane Gay, Hunger

Kiese Laymon, Heavy

Kimberly Dark, Fat, Pretty and Soon to Be Old and Damaged Like Me

Cat Pause (editor), Sonya Renee Taylor (editor) The Routledge International Handbook of Fat Studies

Charlotte Cooper, Fat Activism

Lucy Aphramor is a poetitian — a radical dietitian and performance poet. They developed the health justice approach Well Now.

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