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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. 

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Anonymous
December 21st, 2009
11:12 PM
I am so sorry to hear about what happened with your brother. May he rest in peace and may God Bless your family in these difficult times..

JJ
December 11th, 2009
4:12 PM
Lionel, I am so sorry to hear what happened to your brother. I can relate to his predicament as I too have struggled with weight problems all my life. It's like I don't have an off switch when it coems to eating. Aged 51 I found my condition so bad in terms of back pain, breathlessness and misery I decided to opt for surgery. I am now 7 months out and have lost 86 lbs and am now just slightly overweight. It has not required much 'won't power', just will power to undergo the procedure. I don't want to overeat any more, it has reset my appetite to normal. The procedure I had was a vertical gastric sleeve which was done laproscopically. I went abroad to Brno in the Czech Republic and the total cost was just over £5,000. I know it's too late for your brother but if this post helps anyone else in the same predicament it would make me very happy.

Anonymous
December 8th, 2009
8:12 PM
Social inequality plays a large part in obesity. People see the rich and famous consuming more and more and want desperately to be a part of it. Society feeds into this. But the poor cannot afford diamonds and cars. Instead they fill the emptiness of modern living with battered Mars bars and Burger King. It's no surprise that more equal societies have less obesity. A similar case could be made for mental illness, but here hardly the place.

Shan Morgain
December 8th, 2009
4:12 PM
This is almost entirely a werll written article. Impossible not to wince deeply at your loss at the timing of it just after you wrote so poignantly about your brother. I am glad you called for decency about fat people. But sadly you weighted your piece badly by placing this call halfway through. By then we had seen reference to "the obese as overindulgent slobs." This came as you condemned "fat acceptance" dismissal of the "fat slobs" view. I would share your rejection of the extremes of fat acceptance. Of course most obese people would be healthier and happier, and live longer if they weren't obese. But please note, not all. Research data is not so simple. Some fat people do live long, and some societies who admire fat seem to support healthy weighties. We do not yet understand this. So the issue is NOT so simple as "fat is beautiful" versus "fat slobs." In your analysis I wish you had given at least some information on why it is not only devilishly difficult to shed obesity, but almost impossible. 90% and over who lose weight regain it within 2 years. This is not all due to laziness and greed. Obese people's fat chemistry changes - for good. They put on weight easier, faster, and lose it grudgingly. More fat cells, larger fat cdells, brain settings set too high. The food on sale is bad, if good it's expensive. Many foods have hidden ingredients. Many shops, venues etc have few options for the healthy eater. What is a small lapse for a normal is a major threat to the obese/ ex-obese. Exercise is a big problem. Overdo it slightly you get a twisted tendon dead easily. That means no more effective exercise for weeks, gain weight. Underdo it slightly to protect tendons, you don't lose weight. Similarly maintaining the correct intake is almost impossible. A tiny bit too much, gain. But a tiny bit too little and you are slowly starving without noticing until your immune system is damaged and you get sick. That REALLY crashes weight loss. Maintaining control of what you eat through every waking hour is a titanic discipline equivalent to an Olympic athlete's training. Time of day to eat is vital/ what's available/ measuring its calories/ planning the rest of the intake day in excruciating detail in the busy life/ planning in large amounts of time and energy for exercise/ packing correct food backups wherever you go. Very few of us have this kind of management skill. The famous who lose weight, or maintain weight so flawlessly have highly paid assistants to do a lot of it for them. I could go on. But if you don't have to live with this punishing, almost impossible regime, it's boring and terrifying. If you do, you know it already. I'll end by pointing out that evolution has designed us over millennia to GAIN WEIGHT and KEEP IT. The brain has all kinds of cunning dodges to "help" us hold on ruthlessly to every pound. Once not so long ago our family ancestors survived because of this. There is NO human mechanism built in to aid weight loss. Trying to do it has your own body fiercely fighting you, plus multimillion corporations competing against you. Not to mention society's hatred. That hatred is itself an instinctive knowledge of just how ghastly the state of obesity is. How gruelling it is to fight it. How fatally easy it is to become it. You only need to eat a biscuit, a piece of bread too much every week or so and slowly slowly it creeps on. Very slowly while you don't notice. Until suddenly, you realise. You're stuck in this hideous body that others hate.

Truculent Sheep
December 1st, 2009
6:12 PM
While I feel very sorry for your loss, we all make our own decisions and all the harassment that passes for 'gentle advice' (i.e., bullying) just makes things worse for people. By making obesity such an issue, you are in fact contributing to it being a problem as you maintain the stigma that undermines the self worth of many overweight people and so perpetuates a vicious circle. Happy, well-adjusted people are healthy people. How about a more radical solution, then? It's called being nice and leaving people alone. Sometimes you just have to accept that other people will live their lives their own way. You can scapegoat the 'fat pride' movement as much as you want, but a culture that despises the body is far more harmful to us all.

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