You can want better health without hating your body

This is the piece I have rewritten most, because the conversation it sits in is unusually bad-tempered and unusually stupid, and I did not want to add to either.

On one side: the position that a larger body is automatically a failure of character, and that shame is a reasonable instrument for correcting it. On the other: an insistence that body size has no bearing on anything at all, ever, and that raising the question is itself an act of hostility.

I do not believe either. Most people I know do not believe either. And yet those are the two microphones, so that is what gets said.

What I actually think

Body size does not determine human worth. That is not a soft position or a comforting slogan — it is the load-bearing wall, and everything else in this piece rests on it.

A fat person is not lazier, dirtier, less disciplined, less intelligent, less capable, less attractive or less deserving of respect and care than a thin person. Those associations are prejudices with a long history and no basis, and they do enormous damage — including, demonstrably, inside medical settings, where people are dismissed and under-treated because a number was on file.

And: I am not going to tell you that body weight can never affect health, because that is not true either, and telling women comforting untruths is its own kind of condescension.

Both of those can be true

The reason this conversation goes so badly is that people treat those two statements as though they cannot coexist. As if acknowledging that weight can have health implications requires you to also accept that fat people are morally inferior. As if rejecting that moral judgment requires you to deny anything physical.

They are separate claims. One is about worth. The other is about biology. Collapsing them is the error, and both microphones make it.

Weight is not one thing

The other reason the argument stays stuck is that it treats body weight as a simple output of behaviour, which it is not.

Where a body settles is influenced by an unhelpfully long list: genetics, hormonal and endocrine factors, medical conditions, medications that list weight change as a side effect, mobility, chronic pain, sleep, stress, mental health, pregnancy, menopause, age, and the very unglamorous questions of what food is available near you, what it costs, how much time you have, and whether healthcare has treated you well enough that you are willing to go back.

None of that means every larger person has a medical explanation. Plenty do not. It means the equation has many more terms than the version we are handed, and confident public verdicts about a stranger’s body are being issued by people who have exactly none of the inputs.

Reasons that hold up

People do sometimes decide to change something about their body, and there are reasons for that which I think are entirely sound.

Wanting to climb stairs without stopping. Wanting less knee pain. Wanting more energy at four in the afternoon. Managing a condition alongside a clinician who knows your history. Wanting to be stronger, or to move more easily, or to sleep better. Quality of life, in the plain sense of the phrase.

Those are yours to weigh, with someone qualified, based on your actual circumstances. Not mine, and not a stranger’s in a comment section.

Reasons that do not

To deserve love. To deserve respect. To deserve a seat at a table you are already sitting at. Because someone made a remark at a family gathering. Because thin has been quietly coded as good and fat as bad, and you would like to be on the good list.

Those are not health reasons. They are worth reasons wearing a health costume, and they do not get you what they promise — which is the thing nobody mentions. People arrive at the goal and find the belief waiting for them, entirely intact, having simply chosen a new target.

The consulting room

This is the part of the conversation I care most about, and it gets the least attention.

A great many larger people have had the experience of raising something specific with a doctor — a pain, a cough, a lump, an injury — and having the conversation redirected to their weight before the original complaint was examined. Sometimes that redirection is clinically warranted. Frequently it is not, and the thing they came in about goes unexamined.

The consequence is entirely predictable and it is not that people become thinner. It is that they stop going. They wait longer next time. They arrive later, with something more advanced, having spent months deciding whether it was worth the encounter.

If you want a straightforward argument that stigma is bad for health rather than merely unkind, that is it. The stigma produces avoidance, and avoidance produces delay, and delay is where the actual harm lives.

If this has happened to you, I would say two things. It was not a reasonable standard of care, and you were not imagining it. And it is still worth finding a different practitioner rather than concluding the whole category is closed, because the thing you originally went in about does not go away because the appointment did.

Why shame does not work

It is not only that shame is unkind. It is that it is ineffective at the thing it claims to be for.

Shame makes people avoid. It makes them avoid gyms, swimming pools, changing rooms, photographs, and — most consequentially — doctors. A person who has been humiliated in a medical setting is a person who will delay going back, and delay is where real harm actually happens.

If someone tells you they are humiliating you for your own good, they have told you something about what they enjoy, not about what works.

What I am not doing here

I am not a doctor and this is not medical advice. I am not going to give you a plan, or a number, or an eating protocol, and I would be wary of anyone who offers one without knowing anything about you.

If you are worried about something in your body, that is a conversation for a qualified professional who has your history in front of them. If you have been treated badly by one, that is real and it happens a great deal, and it is worth trying to find another rather than concluding the whole category is closed to you.

Where I land

You are allowed to want to feel stronger. You are allowed to want less pain. You are allowed to want nothing to change at all.

What you are not required to do is despise the body you have while you decide. That part is optional, it is not motivating, and it costs you the years in between.

Take care of the body you have because it is yours and it is carrying you, not because you have concluded it is unacceptable. Those two starting points lead to very different lives, even when the actions look similar from outside.