How Size Acceptance Promotes Health


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Social rejection may increase inflammation in the body.  Or so is the implication of a small study out of the University of California at Los Angeles that found higher levels of inflammatory markers among test subjects who had undergone simulated social rejection.  Which got me to thinking about social rejection of fat people, many of whom are already struggling with chronic inflammation as a result of yo-yo dieting and other health problems.  It’s no secret that being fat carries a huge social stigma.

Then I ran across Guidelines for Therapists who Treat Fat Clients, from the National Association to Advance Fat Acceptance (NAAFA), and I thought it was a great review of some of the primary beliefs that are behind that stigma.  Sorry, I can’t find a link online to send you to the complete guidelines but if you have more time than I do to search, I imagine you’ll find them.

Following are seven assumptions that NAAFA  says affect how therapists view and work with fat people.  I think they apply to more than therapists.  I also think they present a good basis for understanding why the Health at Every Size approach is so logical for helping everyone be healthy and happy.

  • Assumption #1:  You can determine what people are doing about eating and exercise, just by looking at them. NAAFA points out people come in all sizes, and how much we eat and how much we move doesn’t always correlate with size.  Genetics play a significant role.
  • Assumption #2:  Emotional issues cause “excess weight,” and once the issues are resolved, the person will lose weight. Read Assumption #1 again, except this time add “how much we struggle with emotional problems” to the list of things that don’t always correlate with size.
  • Assumption #2a: Large body size indicates sexual abuse, or a defense against sexuality. Hmmm.  Things are getting a bit repetitive here, e.g., check back with Assumption #1 again.  NAAFA does point out that many fat people are comfortable with their sexuality and are sexually active.
  • Assumption #2b:  Fat people must be binge eaters. According to NAAFA, only a small minority of fat people meet the criteria for Binge Eating Disorder (BED).  Likewise, a minority of thin people also do.  NAAFA emphasizes rightly so that an arbitrarily defined weight should not be the goal of treatment for binge eating problems.  Rather, “the focus should be on a sustainable, high quality of life, and on helping the person to accept the resulting body size.”
  • Assumption #3:  If a person is distressed and fat, weight loss is the solution. NAAFA correctly points out, “…the solution to prejudice is to address the prejudice, not the stigmatized characteristic.  What would we do for a thin person in similar distress?  The quality of support the person is able to give herself, and the quality of support available to her in the world, are key areas of focus.”  This also takes us back to the first paragraph in this post.  The stigma adds to the stress, then the stress can cause, or add to existing, health problems.
  • Assumption #4:  Fat children must have been abused or neglected.  Their problems can be fixed by restrictive dieting and rigorous exercise. I can’t say it any better than NAAFA:   “Children need to be supported in using hunger and satiety cues to make decisions about eating, and in valuing their bodies and the variety of bodies in the world.”  My post last week on fat camps for kids gets at this issue, too.
  • Assumption #5:  I am not biased against fat people. This is a good one.  NAAFA says research consistently shows most people hold negative beliefs about fat people.  The organization encourages therapists, and we encourage all of us, to investigate our own beliefs about bodies of different sizes, including our own, and to see the beauty in fat bodies and the strengths of fat people living under oppression.

NAAFA’s guidelines then go on to list the forms of socially-sanctioned abuse fat people face: insults from strangers, family, educators, and acquaintances; surcharges for or denial of insurance or medical treatment, or insistence by medical professionals that weight loss is required for good health and/or for healing any and all presenting complaints; restricted access to jobs, promotions, or advanced education; denial of opportunities to adopt a child; lack of access to adequate seating in theaters, public transportation, restaurants, and even restrooms.


And these are the consequences:  “As with other survivors of stigma, the fat person may have blamed his or her own body for the poor treatment received at the hands of other people.  S/he may have internalized the abuse, with possible consequences such as low self-esteem, depression, social isolation, passivity, or self-hatred.

But a ray of hope:  “As with other survivors of stigma, a fat person may also have used these experiences to develop resilience and powerful skills.”

Then a call to action:  “The therapist will also be called upon to do his/her part in changing the conditions in the broader world which create oppression in the first place.”

I vote we all join in.  Are you ready to?

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About the Author

Marsha Hudnall, MS, RDN, CD

If you’re looking for an embodiment of dedication disguised as obsession, look no further. Marsha is a registered dietitian who has spent the last four decades working to help women give up dieting rules and understand how to truly take care of themselves. Her mission in life is to help women learn to enjoy eating and living well, without worries about their weight. She encourages women to embrace their love of food, which you might call being a foodie. If so, it’s appropriate because being a foodie means you pay attention when you eat. That’s a recipe made in heaven for eating well. Marsha is the President and Co-Owner of Green Mountain at Fox Run.

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