Let’s get something out of the way up front. Dealing with weight issues is an incredibly emotional and sensitive subject, and as a society we should not focus on shaming, shunning, or victimizing the nearly half of the country that is overweight or obese. By creating a societal image of beauty and attractiveness that ostracizes over a hundred million people in the USA alone, we have done ourselves a terrible disservice.
At the same time, we cannot ignore the medical realities that are strongly correlated to being overweight. The amount of diseases and medical conditions with direct causal relationships to weight are staggering, and the evidence is strong and tested. NASH is emerging as perhaps the single largest affliction in terms of both prevalence and incidence, with estimates of over 30 million people currently living in the US with the disease, and the vast majority of them unaware that they have it until it is too late.
Going viral on social media today is an article from the Huffington Post discussing the recent cover of Self Magazine featuring plus-size model and body positivity proponent Tess Holliday, which headlines the Self article blithely titled “Tess Holliday’s Health Is None of Your Business”. The Self article is an interesting dichotomous piece that explains very well the psychological benefits of body acceptance and helps people understand the emotional turmoil that people dealing with weight and body issues go through. It’s overall a good read despite the biased flaws pervasive throughout it and the absolute lack of any discussion of the very real medical risks associated with being overweight.
It also makes a ton of presumptuous logical fallacies about those such as myself that advocate to raise awareness of such risks, while also conflating such concerns with attacks on happiness or beauty. For example:
There’s a certain type of internet commenter that any fat woman on social media is undoubtedly familiar with: The concern troll. If you are a fat woman with the unmitigated gall to present yourself as happy or beautiful, concern trolls will tell you that you are not healthy and should focus on losing weight. They will also often accuse you of “glorifying obesity” for not publicly hating or castigating yourself for existing while not thin. Of course, these folks don’t know how healthy you are or aren’t. But they are determined to “help” you. Yeah. Right.
There are absolutely hateful trolls out there who will shame, attack, and hurl abuse at people for being overweight. I see it all the time. Sometimes they even use “health” as a shield to hide behind. But that isn’t true for all people, and just because a jerk hides behind the health factors while they are trolling doesn’t mean that those health factors are not factually accurate. And while it is absolutely true that Tess Holiday’s health IS her business, she also acts as a public voice in the body positivity movement, advocating for blanket acceptance of overweight people without any recognition or acknowledgement of the risks associated with it. As another wrote earlier this year wrote about a similar public figure: “Your Denial gets to kill you. It shouldn’t kill — or defame — anyone else.”
The HuffPo piece doubles down on this defensive rhetoric:
I instantly imagined the popular response to such an in-your-face cover choice. What? But that’s bonkers, people would say. Look how fat she is! Of course her health is our business! Her whole body is our business! Fat bodies are, after all, still perceived as public property ― reach a certain stage of fatness and you will rapidly learn that people feel entitled if not compelled to tell you what you are doing wrong, even if you are total strangers, because being that fat evidently means you cannot be trusted with your own body and are in need of outsiders to instruct you on the finer points of body-having.
I’ve written about this before, using the following analogy. If you saw someone heavily bleeding or looking gravely ill on the street, you would try to help them. Because they are not well. After losing my Mom suddenly to NASH a few years ago, I’ve spent years learning about the disease, and the correlation between obesity and NAFLD/NASH is well established. If you are obese or even simply have a lot of visceral fat, you have a greater than 50% chance of developing some form of fatty liver disease. And since we have such a difficult time diagnosing NASH, most people are completely unaware of the condition. Toss in the fact that there is no cure, and you get the relatively unknown pandemic we are facing.
Therefore raising awareness is crucial, and this means finding a way to have thoughtful and compassionate conversations about the health risks with those that are quite possibly already unwillingly suffering from the disease. This is hard! People take criticism about weight very personally, for very good reasons. Society has made any real discussion incredibly difficult. The author of the HuffPo piece rightfully points out that corporations have picked up on body positivity not as a mental health issue but as a retail trend. This is lamentable, but at least there is a tangible benefit to be gained.
I wish brave role models like Tess and the writers at Self and HuffPo would also talk about the health issues that need to be included in body positivity conversations. Tess’s life story is one of overcoming immense tragedy and social stigmas and finding success and happiness, which is admirable. She has undoubtedly served as a terrific role model for many millions of people and has brought happiness and positivity to many, many lives. But separating what is beautiful or how to feel happy from what is healthy is critical to advancing awareness of diseases like NASH. People with cancer can be beautiful and happy with their lives while also acknowledging that they are sick. Body positivity must move in the same direction. This year more than 200,000 women will be diagnosed with breast cancer. More than 3,000,000 will develop NASH. That’s staggering.
Here’s even more shocking statistics. Globally, rates of NAFLD are above 24%. That’s over 1.8 billion people. Recent studies have shown rates of progression from NAFLD to NASH and eventually fibrosis as high as 44%. That’s 800 million people. In the USA alone, one third of the population or nearly 100 million people has NAFLD, with estimates of NASH prevalence as high as 30 million people. And most people have no idea that they have either condition. We must find properly sensitive yet factual ways to address obesity and increase awareness of these dangers.
The only saving grace with NASH vs other terrible diseases is that if you intervene early enough with healthy lifestyle changes the disease can be halted and even reversed before it is too late. This requires doctors, family, friends, and yes even body positivity proponents to help inform those at risk. People of all body types and appearances should be celebrated and allowed to live free from shame, doubt, and fear. But to deny the well-known health risks just to avoid tough conversations is the wrong way to promote positivity.