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We Need to Talk about Obesity, Again. - By Dr. Stephanie Hart

I originally posted this in a Facebook group for physicians after a thread took a pretty worrisome left turn on the topic of obesity – specifically, sex while fat. This happens a lot, because the culture of medicine is fat-phobic and literally killing people. I think this is a subject that needs frequent re-iteration. I think it’s important for me to say that the word ‘fat’ is being used here for a reason. It is a word many of us are reclaiming, a word not associated with doctor’s offices and humiliating lectures, a word once used to harm us that we are taking back. That said, if you’re reading this and you’re not fat, you probably shouldn’t take this as permission to use that word yourself. What word should you use? Ask the patient in front of you what word they’re most comfortable with. Some like ‘obese’. Some prefer to talk about weight, or larger bodies. Some would rather you not talk about it at all – and that’s rather the point of this entire thing. Alright, with that out of the way, let’s go.


Okay people, it’s me again and we need to talk about obesity.


Again.


Let me just say, first of all, that being fat is not, by itself, a reason someone can’t have sex, can’t feel pleasure, can’t have desire, can’t orgasm, or any other sexual dysfunction. Yes, some people struggle with confidence and self-esteem when they’re fat and that affects their sex lives. No, not all of them. And many thin people have the same confidence problems for a host of other reasons - no one assumes they can’t have sex because of this. No one tells them to change their body because of this. If anyone questions this, please Google “FUPA porn” and enjoy the many obese women who make more money than I do filming their fat bodies doing sexy things.


Second let me say this: Fat, by itself, is not a measure of health, stamina, or ability to move or exercise. It is absolutely possible to weigh 400 pounds and still be flexible enough to reach your own genitals. Or your toes. It is possible to be fat and not have diabetes, heart problems, or other chronic conditions. It is possible to be an athlete and have a BMI above 35 - or even above 40. It is possible to be fat despite a healthy diet, regular exercise, and no major mental health concerns. There are no diets with long-term outcome data proving efficacy. The longest study is well less than 5 years. Some people are fat no matter what they do. And their weight does not necessarily correlate with their life expectancy. Anyone who questions this, please look up several good studies on which BMI has the best life expectancy (spoiler alert: it’s above 25). Also please google “fat yoga” and enjoy helpful videos of fat women who can do amazing feats of athleticism despite their thighs, their boobs, or their bellies.


That said, if someone doesn’t have a healthy diet or a good exercise regimen, and weighs more than medicine would indicate is ‘optimal’, they still deserve dignity and kindness and care. They don’t deserve to be lectured every time they just need a pap smear. They don’t deserve to be treated as though they are stupid, lazy, or mentally ill. Fat people know they’re fat. Truly. But like any chronic disease, living with it can be exhausting and not everyone can always do a good job of taking care of themselves. That doesn’t give anyone else the right to treat them poorly. If you wouldn’t treat a Rheumatoid Arthritis patient who couldn’t tolerate their meds poorly when they show up inflamed, you shouldn’t treat a fat person whose diet isn’t perfect any worse.


Third: not every thin person is healthy. Not all of them exercise or eat vegetables. Some of them eat nothing but chips and drink nothing but coffee and coke. Some of them are thin only because of extremely dangerous behaviours that are far more terrifying than any fat person’s diet. You cannot assume you know anything about a person’s lifestyle based on their waist circumference. If you’re going to talk diet and exercise with fat people, you’d better be just as enthusiastic about it with thin people, or you’re a fat-phobe. And unless you have training of some sort in obesity management, you probably shouldn’t be starting a conversation about weight loss at all. (That doesn’t mean you shouldn’t help people who ask for it directly. It also doesn’t mean you should never tell people that moving their body more or eating more vegetables is good for you. It just means your goal in telling them that should generally be better health or function, not losing weight).


Fourth: yes, there are things that are more difficult when people are fat. Missionary position is one. So is orthopedic surgery. But do you want to know the one thing that never made any of that better? Telling someone to lose weight. In fact, as an example, there are good studies showing attempted weight loss prior to joint replacement is a bad idea. Many of the worst complications of surgery on fat people are likely entirely avoidable if we did even a tiny bit of research on how to manage these sorts of things, instead of only funding research on how to make fat people less fat.



Here’s my conclusion: Fat people know they are fat. They know it’s sometimes linked to certain health problems. They already probably feel awful about it, and if they don’t it’s through years of therapy and relentless pursuit of body positivity (and no, body positivity is not the same as promoting fatness, so don’t go there). Some of them have sexual hangups because of their fat. Some of them have sexual dysfunction or health problems that have abso-fucking-lutely nothing to do with their weight but they will still be ignored, dismissed, and shamed rather than assessed, because they are fat. Please don’t be that person. Don’t see their fat first.


Don’t see my fat first. I’ve got a pretty nice smile, alright? I appreciate it when you notice that before you start wondering about my carb intake.




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