Time’s recent article by fat rights scholar and activist Abigail C. Saguy is disappointing on two counts. First, like many of the articles published in support of the burgeoning pro-fat movement, it relies on poor science and even poorer statistical analysis. The title—“If Obesity Is A Disease, Why Are So Many Obese People Healthy?”—would be more at home at The Onion than a legitimate news source. Yet, the true failing of the article is its bald mishandling of the statistics it presents.
The Time article argues that because half of overweight people have normal cardiometabolic profiles and almost one-third of obese people have normal profiles (compared to three-fourths of people of average weight), fat and health should not be conflated. As one savvy commenter points out, these comparisons actually suggest that overweight individuals are at twice the risk of developing metabolic abnormalities, and obese individuals are 2.67 times more likely to develop them. While the author points to several behaviors that improve health outcomes regardless of weight, like being physically active and adopting a Mediterranean diet, none of the evidence she provides denies that carrying an excess amount of fat is deleterious to one’s health. Saguy calls for doctors to recognize that “there are both metabolically healthy and metabolically unhealthy individuals in each category of weight” while conveniently ignoring that obese individuals face highly elevated risk regardless of their lifestyles. As much as the author insists measures of body mass index do not differentiate between bone, fat and muscle, the vast majority of individuals with BMIs of 30 or higher (the CDC’s definition of obesity—equivalent to a 5’9″ individual weighing 203 pounds) owe their weight to excess fat. This excess fat increases their risk of high blood pressure, heart disease and congestive heart failure independent of other risk factors.
Unfortunately, the majority of commenters use the findings to claim that there is no meaningful link between obesity and health, and therefore that intolerance of obesity is unfair. More concerning than the shoddy statistics, however, is how the article has been used by fat rights activists. By framing their argument in health-related terms, the pro-fat movement risks embracing the same fallacy accepted by past civil rights movements: that health is a permissible basis for discriminating against others.
Health concerns, either real or fictional, have long been the cornerstone of some of history’s most egregious human rights abuses. Discrimination against minorities is almost always cast in terms of infection. Almost every historically despised group whether it be Blacks, gays and lesbians, Jews, the Roma people or even hippies has had the word “dirty” appended to their name in an effort to arouse cultural disgust against them. Historically, the response of these marginalized groups has been to place their most clean-cut representatives front and center in an effort to give the lie to the false accusations leveled against them.
More recent civil rights movements have been faced with the dilemma of confronting prejudice when allegations of disease are not entirely false. The gay rights movement faced this dilemma in the 1980s when for a brief moment in history the disease we now know as AIDS was labeled Gay Related Immune Disease or GRID. Although secular Americans were already beginning to reject religious arguments for animus towards gays, they were highly susceptible to disease-based disgust. Just as the untouchables in India were once forced to wipe their footprints away, many HIV-positive people were asked to bring their own cleaning supplies to purify the surfaces they touched.
A series of publicity campaigns highlighting the existence of GRID outside the gay community (and successful lobbying resulting in an eventual name change) helped to lift this stigma, but the crisis has left a legacy of health discrimination within the gay community. For evidence of this, one need only consider the recent Harvard campaign for the repeal of the FDA’s gay blood ban. Rather than calling for a set of orientation-neutral standards, activists asked that healthy, monogamous, gay and bisexual men be excused from the ban. It’s no accident that well-exercised non-smokers are overrepresented in LGBT equality ad campaigns. The movement continues to subtly promote an agenda that links health to equality.
The final line in the sand for many equality movements has been to point out that the characteristics of the group in question are a matter of birth, and thus health-based discrimination is unfair. The “born this way” argument has been highly successful for the gay rights movements, and some fat-rights blogs have begun to point to evidence linking obesity to heredity. While these arguments may have a strong scientific foundation, they also sidestep the ultimate question of eugenics that rears its head with every new equality movement. As Cynthia Nixon, a lesbian actress who was criticized for describing her orientation as “a choice,” puts it: “It doesn’t matter if we flew here or we swam here… it matters that we are here.”
As discrimination based on race, religion, and sexual orientation continues to disappear from the developed world, per se health discrimination has only increased. Campaigns against smoking and obesity rely on the same “dirty” rhetoric of their predecessors, inundating viewers with illustrations of how truly disgusting the lungs and arteries of the unhealthy are. While these ads aim to protect a new generation from unhealthy lifestyles, they also unfairly stigmatize those who cannot stop smoking or are unable to lose weight. As a result, smokers and the obese often face reduced housing and employment prospects. Unsurprisingly, the brunt of this stigma falls on the poor and working class who have higher rates of smoking and obesity than the general population.
Instead of proposing that they really are equally healthy, or “born this way,” fat rights activists would do better to focus on their right to existence and self-determination as human beings. Even if obesity generally results in reduced health (and it does), we have a duty to consider this fact alongside the fat community’s right to human dignity. We must assess how the benefits of targeting unhealthy lifestyles compare with the costs of demeaning and degrading the people living those lifestyles.
As much as marginalized groups complain of being “treated like lepers” or “avoided like the plague” we have rarely reconsidered how we treat the actual lepers and plague sufferers. The fat rights movement has the potential to fundamentally alter the way we talk about health-based discrimination, but only if they make the right arguments.