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

Lucy Aphramor
4 min readApr 19, 2021

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…



Lucy Aphramor

Lucy Aphramor is a radical dietitian and performance poet. They are Associate Professor of Gender, Power, and The Right to Food at CAWR, Coventry University UK.