Not long ago, "weight diversity speakers" advocating "fat acceptance" for the "fat pride" community would have been a gag on the US TV satire The Daily Show. Nowadays, they're a forceful voice in American politics.
Authors such as Marilyn Wann (Fat? So!) and Linda Bacon (Health at Every Size) challenge the assumption that fat is a problem. For the two-thirds of Americans now overweight or obese, their message is beguiling: being heavy does not equate with being unhealthy. What's really required is a cultural attitude shift, whereby we stop sneering at the obese as overindulgent slobs, accept the high calorie habit as a defensible lifestyle choice and expand our aesthetic to embrace fat as beautiful.
Sure, artists from Rubens to Botero have celebrated the magnificence of mass, and Western standards of beauty have grown literally too narrow. In a cheesier vein, Channel 4's How to Look Good Naked presenter Gok Wan has laudably campaigned to restore the concept of the voluptuous and to ameliorate female self-loathing. Yet denying the link between obesity and poor health defies medical fact.
I have an older brother about whom I write with some reluctance, because I feel protective of him. He's topping 330 pounds: 24 stone. He was once 5ft 7ins tall, but his vertebrae have compressed, and at 5ft 3ins I now look him straight in the eye. I used to look up to him in every sense. I ended our last two visits in tears. My brother breaks my heart. He's obscenely smart, testing in adolescence (to the irritation of his siblings) as having a genius-level IQ. He's a well-read, intellectually adventurous man who can talk your ear off about why a meniscus is either concave or convex. But he's also a sadly good test case for the claim that one can be "healthy at every size".
My brother has diabetes, and has a blood-sugar level — normal being about five gm — of 11.5. His feet swell so that they don't fit in his boots. A bout of congestive heart failure nearly killed him. He can barely walk, and venturing out of his studio apartment is an ordeal. Obesity exacerbates his emphysema, and he drags a portable oxygen tank with him like a faithful dog. Not long ago, the tank's battery died at a bus stop. My brother went into respiratory arrest, and only a good Samaritan who rushed off the bus got him to hospital in time to save his life. Every time I talk to my brother, I wonder if it's for the last time. Planning to see him during an author's tour in March, I'm counting the days, actively anxious that he won't still be with us three months from now.