“You Just Need to Lose Weight”

1. Anti-fatness is pervasive and harmful, not a choice or personal failing

Fat people are neither created nor defined by trauma, disordered eating, or some vague idea of emotional dysfunction.

Pervasive bias: Anti-fatness is deeply ingrained in society, manifesting in discrimination, harassment, and exclusion of fat people. This bias is often justified by framing fatness as a personal choice or moral failing, ignoring the complex factors that influence body size.

Multifaceted causes: Body size is influenced by genetics, epigenetics, hormones, socioeconomic factors, and more. Simplistic "calories in, calories out" explanations ignore this complexity. Even when weight loss is achieved, most people regain the weight within a few years due to biological adaptations.

Harmful impacts: Anti-fat bias leads to:

• Employment discrimination and lower wages
• Poorer quality healthcare
• Social stigma and isolation
• Mental health challenges
• Barriers to accessing public spaces and services

2. Weight loss is complex and often ineffective long-term

A 2015 study found that the probability of very fat people reaching their BMI-recommended weight were extremely small: 1 in 1,290 for very fat men and 1 in 677 for very fat women.

Biological adaptations: When people lose weight, their bodies undergo hormonal and metabolic changes that increase hunger and decrease calorie burn, making it extremely difficult to maintain weight loss long-term.

Ineffective interventions: Most weight loss methods show poor long-term results:

• Diets: Lead to short-term loss but most people regain weight within 1-5 years
• Exercise: Important for health but has minimal impact on weight alone
• "Lifestyle changes": Often rebrand restrictive diets without addressing root causes

Health at every size: Research shows health improvements can occur independent of weight loss through behavior changes. Focusing on weight loss alone often leads to yo-yo dieting, which can be more harmful than maintaining a higher weight.

3. BMI is an flawed and outdated measure of health

Like phrenology and positivist criminology before it, the body mass index is a product of its social context, which proudly held up whiteness as an idealized kind of normalcy.

Racist origins: The BMI was developed in the 19th century using data solely from white European men. It was never intended to be used as an individual health measure, yet it became the default standard worldwide.

Inaccurate tool: BMI fails to account for:

• Body composition (muscle vs. fat)
• Distribution of body fat
• Racial and ethnic differences in body types
• Overall health markers beyond weight

Perpetuating bias: The widespread use of BMI in healthcare and public policy reinforces anti-fat stigma and leads to misdiagnosis and improper treatment of both fat and thin patients.

4. Medical bias against fat people leads to poorer health outcomes

Fat patients actually overestimate the respectful treatment we'll get from doctors, and that "few patients underestimated physician respect."

Widespread prejudice: Studies consistently show high levels of anti-fat bias among healthcare providers, including doctors, nurses, and medical students. This bias leads to:

• Shorter appointment times
• Less emotional rapport
• Misdiagnosis of symptoms as "just" weight-related
• Delayed or denied treatment

Avoiding care: Many fat patients postpone or avoid seeking medical care due to past negative experiences, leading to poorer health outcomes.

Intersectional impacts: Fat patients who are also Black, Indigenous, disabled, or hold other marginalized identities face compounded discrimination in healthcare settings.

5. "Obesity epidemic" rhetoric fuels discrimination, not health

Our cultural conversations about weight loss drowned out both Flegal's findings and a crucial opportunity for a more nuanced conversation about fatness and health.

Manufactured crisis: The "obesity epidemic" narrative gained traction in the late 1990s and early 2000s, driven by a combination of:

• Lowered BMI thresholds that suddenly classified millions as "overweight"
• Increased funding for obesity research
• Media sensationalism
• Weight loss industry influence

Harmful impacts: This rhetoric has led to:

• Increased anti-fat bias and discrimination
• Ineffective and often harmful public health policies
• Diversion of resources from more pressing health issues
• Psychological harm to fat people, especially children

Nuanced approach needed: Research challenging simplistic views of weight and health is often ignored or suppressed, preventing a more holistic understanding of body diversity and well-being.

6. Fat people face widespread discrimination in daily life

From café chairs to bus benches, bathroom stalls to airplane seats, the built environment is reliably designed for thin, nondisabled people.

Employment: Fat people face hiring discrimination, lower wages, and fewer promotions.

Public spaces: Many environments exclude or make life difficult for fat people:

• Transportation (narrow seats, seatbelt extender policies)
• Entertainment venues
• Restaurants and public seating
• Clothing stores with limited size ranges

Social stigma: Fat people often experience:

• Harassment and bullying
• Romantic rejection or fetishization
• Assumptions about health, intelligence, and character

Legal landscape: Most jurisdictions lack protections against weight-based discrimination, leaving fat people with little recourse.

7. Body positivity has been co-opted and diluted

Body positivity that fails to interrogate biases and systems of oppression will replicate them.

Radical roots: Body positivity evolved from the fat acceptance movement, which challenged systemic discrimination and sought liberation for fat people.

Corporate co-option: Mainstream body positivity often:

• Focuses on individual self-esteem rather than systemic change
• Centers thin, white, able-bodied women
• Promotes consumerism under the guise of empowerment
• Excludes very fat people, disabled people, and people of color

Exclusionary practices: Many "body positive" spaces still promote:

• Weight loss as a valid goal
• "Health" requirements for acceptance
• Limited size diversity (accepting "curvy" but not very fat bodies)

8. Addressing anti-fatness requires examining privilege and bias

If we are to fight individual body shaming together, thin people need to interrogate their own complicity in anti-fatness, confront it when they see it, and allow fat people to speak to our experiences without drowning us out.

Recognize privilege: Thin people benefit from societal anti-fat bias, even if they struggle with body image. Acknowledging this is crucial for effective allyship.

Examine assumptions: Question ingrained beliefs about:

• The relationship between weight and health
• The morality of different body sizes
• Who "deserves" respect and access to resources

Take action:

• Interrupt anti-fat comments and "jokes"
• Advocate for size-inclusive policies and spaces
• Center fat voices in conversations about body politics
• Support fat-led organizations and businesses

Ongoing work: Dismantling anti-fatness is a continuous process requiring self-reflection, education, and active efforts to create a more just and inclusive society for people of all sizes.

Last updated: January 23, 2025