What is Health?: A Case for Expanding the Definition
DISCLAIMER: The word “fat” is used here as simply an adjective to describe larger bodies per those active in the Fat Liberation Movement, not as a pejorative as it is commonly known.
According to Oxford Languages:
health /helTH/ n.
1. the state of being free from illness or injury.
2. a person's mental or physical condition.
3. used to express friendly feelings toward one's companions before drinking.
Contrary to the definition above (although I can get behind number 3!), the World Health Organization (WHO) says, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." While the WHO's definition more closely parallels my thoughts about health and advocates for a more holistic view closely aligned with Health At Every Size®, diet culture -- and, by extension, the medical field -- isn't letting go of the thin-equals-health ideal any time soon. But, why is it problematic?
Let's take a closer look.
Narrow in Scope
By using the current paradigm, an all-or-nothing way of looking at health is employed that favors physical health above all other areas. For example, weight loss is often the prescribed treatment for any number of presenting conditions from indigestion to joint pain. But the impact of intentional weight loss -- and we're talking the ACTIVE PURSUIT of weight loss, not weight loss in general -- is often detrimental to mental health and social well-being. Attempting intentional weight loss has been linked to increased instances of depression, low self-esteem, and disordered eating...and simply doesn't keep the weight off for most folx past 2-5 years.
More than that, the current paradigm places the pursuit of health on the individual -- a viewpoint that neglects many other health determinants outside of the individual and ignores the fact that illness and injury are a part of life, as well as body size being as equally diverse as skin tone, eye color, and height. In fact, studies have shown that social determinants are a better indicator of a person's health status than individual health behaviors.
In other words, diet and exercise are less likely to have a significant impact on overall health status than social determinants and biological factors. Therefore, let's widen the scope of health to include these areas too.
Promotes Weight Bias
Because of this narrow definition of health, weight bias is rampant in our culture and promotes healthism, ableism, ageism, racism, and more. But just what is weight bias?
According to a World Health Organization study on weight bias and "o*esity" stigma:
"Weight bias is defined as negative attitudes towards, and beliefs about, others because of their weight. These negative attitudes are manifested by stereotypes and/or prejudice towards people with overweight and o*esity. Internalized weight bias is defined as holding negative beliefs about oneself due to weight or size.
Weight bias can lead to o*esity stigma, which is the social sign or label affixed to an individual who is the victim of prejudice. O*esity stigma involves actions against people with o*esity that can cause exclusion and marginalization, and lead to inequities – for example, when people with o*esity do not receive adequate health care or when they are discriminated against in the workplace or in educational settings."
Many fat folx often have stories about dismissive treatment by doctors and other medical professionals -- including mental health professionals -- and overhearing degrading comments by random strangers, coworkers, or by their own family and friends. For someone living in a larger body, the blaming and shaming stemming from weight bias is all-encompassing and can have terrible ramifications for their health and safety, which have no connection to higher weight in and of itself.
Limits Treatment Options
Because of weight bias in the medical world, the wide array of treatment options offered to those in thinner bodies are often limited to intentional weight loss for folx in larger bodies.
Don't believe me? Try this: Open up a new browser tab and search for any common health concerns from asthma to urinary incontinence. No doubt there will likely be mention of weight as a probable cause and weight loss as treatment.
The problem here is that people of all shapes and sizes can present with any number of conditions; there is not one single health condition that strictly occurs in fat folx, but we know that nurses and physicians often have limited respect for those in larger bodies. This might account for stories in which more effective treatments are offered to those in thinner bodies and not to fat folx.
Poorer Health Outcomes
If the concerns of people in larger bodies are dismissed and they are instructed to simply lose weight, it's no wonder many avoid going to the doctor altogether, which leads to not seeking care until it is absolutely necessary. I've not met a single person who appreciated being guilted and shamed by a person they are paying to provide care, so why put up with it if it's not absolutely necessary?
But this generally means, however, that fat folx often don't receive care until illness or injury have progressed to a point that there may be serious long-term repercussions or even death. In her book What We Don't Talk About When We Talk About Fat, Aubrey Gordon writes about several fat folx whose concerns about sudden onset symptoms were ignored by doctors and told to lose weight only to find serious underlying conditions after significant progression. One healthy teen lost a lung due to an unchecked blood clot that stopped circulation and killed the surrounding tissue. This could have been prevented had her doctor ordered routine tests, but instead ordered weight loss.
Collectively we need to consider the impact of weight bias and delayed treatment for fat folx, who may be "sicker" and dying at higher rates than those in thinner bodies. Side note: There are plenty of studies that disprove this notion altogether and actually speak to the longevity of those in larger bodies with strong cardiovascular fitness.
False Equivalencies
Many assumptions abound about larger bodies and the impact of weight on health that are simply not borne out by scientific evidence. Taking a deeper look at the funding of and bias within various research studies, it is clear the intentions of studies from the get-go have an agenda but these are the ones that so often get publicity, thus these myths persist in the public mind and the medical world.
For example, popular belief holds that those in larger bodies are inherently less healthy than those in thinner bodies. But, as discussed above, there are plenty of factors to consider when making this assumption. Further, studies have actually shown that there may be a protective factor to carrying some extra weight, especially in the case of being hospitalized.
Promotes Systemic Oppression of Larger Bodies
When public health policy is based on false equivalencies, the common good suffers collectively while scapegoating a select segment of the population. Implicit bias implemented into public policies, then, constructs the foundation for straight-up oppression of those scapegoated.
How often have you heard the argument that “o*esity” is expensive and a drain on resources in our healthcare system? And, yet, funding is funneled to "health care initiatives" that promote weight loss and weight management despite the fact that weight cycling (dieting and weight regain) have been repeatedly shown to increase health risks. But the general implication with this line of thought is that a) larger bodies do not deserve adequate healthcare and b) larger bodies should be eradicated. Hmm...has a bit of a eugenics feel, doesn't it?
The fear of fat in our society is more detrimental to overall health than the fat itself. Not only are people trying desperately to not be fat through whatever means necessary, but then the general treatment -- both medically and socially -- of those who are fat has a profound negative impact on long-term health outcomes for them, which runs totally counter to the goal of developing a healthier society.
How Might We Look At Health Differently?
Health should be viewed more holistically to extend beyond the physical to include emotional/mental, social, and spiritual health as the WHO's definition of health suggests. Illness and injury are a part of life and there is not a single soul who has lived their life without experiencing either, so why continue with this silly notion that proper diet and enough exercise will ensure a long, healthy life? Because there are so many other factors involved!
Further, we need to expand the definition of health to look beyond the individual to societal, cultural, and environmental factors as well. We can do everything within our power as individuals to ensure health, but there are so many things we realistically don't have any control over.
Social factors, such as education and income bracket (among others), have also been demonstrated to have an impact on overall health outcomes. The issue of health insurance comes to mind here: If one is employed full-time, their employer generally covers some or all of the cost of an employee health insurance plan. However, there are many people in the US that work part-time, are self-employed, or unemployed that do not have easy access to affordable health insurance (despite the passage of the ACA) and a lot forgo medical treatment because of the cost of insurance or the cost of services even if they have insurance. A population not accessing health care due to cost or access barriers cannot be a healthy one and can't be placed at the feet of the individual.
If we are to truly have a healthier society, we need to expand the definition of health, look beyond the individual, and ensure access to high-quality, weight neutral healthcare is possible for everyone. This is where the Health At Every Size® paradigm and its five principles come in. It takes a both/and approach to health and allows for people to make their own decisions about it.
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Bottom line, someone's health status -- nor weight or body size -- should not determine their worthiness as an individual and all people, regardless of health status or behaviors, should be treated with dignity and respect. PERIOD! That is what expanding our current definition of health would do!