Fat v Obese

File this under ‘I’m So Involved In Fat Acceptance That I Forget How Daft The Rest Of The World Is’.

Anne Milton MP, Parliamentary Under Secretary of State for Public Health in the Conservative-Liberal Democrat British government, stated that health care workers should use the word ‘fat’ rather than ‘obese’ in order to encourage people to lose weight. Apparently, people distance themselves from the term ‘obese’ whereas labeling people as ‘fat’ would encourage “personal responsibility”. Professor Steve Field, of the Royal College of GPs agreed with the statement, saying “The term obese medicalises the state … It makes it a third person issue. We need to sometimes be more brutal and honest.”

The National Obesity Forum, however, criticised Ms Milton’s views. Spokesperson Tam Fry stated, “Being obese is an internationally accepted medical definition where one’s weight is so extreme that there is a risk of comorbidity of stroke, diabetes type two [and] heart disease. Obesity is a wake-up call to do something about weight. It’s not just being fat.”

There is so much facepalm in this story but I will distill it into five main points:

1. Fat Acceptance 101: Health is not determined by weight.

While fat is correlated with diseases such as Type II diabetes and heart disease, studies have not shown that fat actually causes these conditions. Not to mention it’s pointless to encourage weight loss in patients as diets don’t work. Of course doctors should be encouraging healthy lifestyles in their patients, but they should not be framing this discussion around weight.

2. Shame doesn’t help anyone.

If shame helped people lose weight, there wouldn’t be a single fat person in the Western world.

3. We don’t need to give health care professionals permission to act like arseholes

According to Ms Milton, too many National Health Service staff were reluctant to use the term ‘fat’ for fear of offending their patients. I doubt this, as research has shown anti-fat bias in health care professionals (see here and here), Yale’s Rudd Center for Food Policy and Obesity explicitly states that “Weight Bias is common in health care settings” and First, Do No Harm is filled with horror stories of the poor treatment fat patients have experienced from health care professionals.

Though Ms Milton was speaking in a personal capacity, her position in the British government means that her words can be taken as institutional permission for doctors to disrespect their patients.

4. Fat people know they are fat


5. ‘Fat’ should be used instead of ‘obese’

I actually agree with Anne Milton on the topic of fat v obese, but not for the reasons she listed. I think ‘overweight’, ‘underweight’ and ‘obese’ are unnecessary terms that should be eradicated because the body mass index is a flawed concept.

‘Fat’ has become a pejorative term and now has so many negative attributes connected to it – lazy, gluttonous, smelly, inferior, unattractive – when it is just an adjective. I think we should be using it more often because only then can it become normalised. The word ‘fat’ need not be “brutal”. It certainly shouldn’t be a trigger for so-called “personal responsibility”. It’s just three little letters that tell you as much about me as my biracial blood, my short-sightedness and my curly hair.

Sources: The Guardian, Sydney Morning Herald, News.com.au


29 Responses to “Fat v Obese”

  1. 1 Luxe 2 August, 2010 at 1:34 pm

    Thank youuu I detest BMI. Part of the reason I sympathize with FA is because I’m underweight according to BMI but perfectly healthy so of course it stands to reason there must be people in the other BMI categories who are perfectly healthy too.

    • 2 Frances 2 August, 2010 at 1:39 pm

      The categories are so daft. Like ‘underweight’ and ‘overweight’: of what? A horse? A tractor? Or an arbitrary decimal place?

  2. 3 Living 400lbs 2 August, 2010 at 2:02 pm

    Fat Acceptance 101: health is determined by behaviours, not by body type.

    I would say “Health is not determined by weight”. Health owes a lot to heredity too, not just behavior.

  3. 5 papumorgado 2 August, 2010 at 2:41 pm

    Loved your post, it’s informative and precise. I’ll recomend it as a must read! Thanks!

  4. 6 Veronica 2 August, 2010 at 9:51 pm

    I don’t know where to start on the idiocy in that article(s), so I’ll just say to you: Well said!

  5. 7 PlusSizedWomanist 2 August, 2010 at 10:20 pm

    I take umbrage with the “Being obese is an internationally accepted medical definition where one’s weight is so extreme that there is a risk of comorbidity of stroke, diabetes type two [and] heart disease. Obesity is a wake-up call to do something about weight. It’s not just being fat.” statement made by the National Obesity Forum.

    I’m obese by the Bullshit Maniacal Index’s standards. My weight is NOT extreme. Not at all. I’ve always hovered in the obese category, even at my lowest healthy weight. That’s my NATURAL WEIGHT. But according to these blowhards, no matter what I should be shamed to high hell until I get into the “acceptable range” of weight, which won’t happen without me seriously starving myself to death or by exercising myself to death. Sorry, I have a life to live.

    And do we really want to push doctors to disrespect fat patients even MORE than they already do? So we’re going to discourage fat people from maintaining their health even MORE by creating MORE aversion from the doctor? Because all of our morality wars have gone SOOO well. *points to America’s War on Drugs* Yeah….

  6. 10 JeninCanada 3 August, 2010 at 2:08 am

    Personal responsibility my ENTIRE ass. If being fat is mostly genetic, and then influenced during life by so many things out of our control, being fat, or not being fat, is NOT about ‘personal responsibility’.

  7. 11 wriggles 3 August, 2010 at 2:44 am

    …where one’s weight is so extreme that there is a risk of comorbidity of stroke, diabetes type two [and] heart disease. Obesity is a wake-up call to do something about weight. It’s not just being fat.

    No, this is the headless fatty definition of “obese”. The actual definition is that of a BMI of 30 or over, as he well knows.

    It’s also hard not to laugh at his wording of, “there’s a risk…” sorry, but there’s always a risk until you actually expire. It shows part of people’s investment in fat=sick is anxiety about death displacement.

  8. 12 wriggles 3 August, 2010 at 2:46 am

    Oh, and I forgot to say, I’m glad he himself mentions, just being fat isn’t in itself, disease. Which rather undermines the whole obesity conceit.

  9. 13 Lisa 3 August, 2010 at 9:08 am

    Wonderful post. I work in health care and I am a size 16 US. I find it so ironic that we have so many plus sized health care workers who are turning around and saying “diet and exercise are key for your health,” to our patients when 1/2 of them are even larger than I am.

  10. 14 BuffPuff 3 August, 2010 at 10:36 am

    I just blogged about this too.

    Personally I’m cool with the word fat since I elected to reclaim it as a neutral descriptor 25 years ago. But I’m in a tiny minority in the UK. Most Brits use it as an insult and Anne Milton has obviously bought into every negative stereotype the word has come to evoke, with all her sanctimonious blather about “personal responsibility” and belief that fat people don’t know they’re fat (or else are too thick to grasp what obese means). Don’t you just love it when people who aren’t fat assume they have a clue about what goes on in actual fat people’s heads?

    The thing that really rankles with me is having a health minister who believes insulting those she considers to be sick will improve their health.

    And don’t get me started on Tam Fry. He makes MeMe Roth sound almost rational:–

  11. 15 alisondee 3 August, 2010 at 5:52 pm

    It seems as though the 11th commandment is ‘thou shalt not be fat’ *sigh*.

    I agree with everything you have written.

    What an effed up world we live in. Screw the poor people, there are fats running all over the place. Disaster !!!

    I hope you all hint the sarcasm in my tone !

  12. 16 eelt 4 August, 2010 at 9:36 am

    How someone like Anne Milton can purport to be a public health minister is utterly beyond me. Instead, it seems to me she represents the contempt the Tory party has for public health – after all the Tory party is the party of the privileged, while genuine public health is the most powerful weapon in the arsenal of those who want to help the poor.

    When I read her opinions of how fat people should be treated, I was really shocked, and I set out to find responses from within the UK. If an American or Australian minister made a statement like Anne’s, she would have faced a serious backlash from the fat acceptance movement in those countries. Not so, it seems, in the UK.

    This is what I found so far (I’m excluding responses from American and Australian blogs here):

    The real thing: Fat acceptance responses:
    That’s about it!

    Sympathetic writing from other sources:
    This is really a libertarian blog, the author doesn’t seem really aware of fat acceptance, but is least very sarcastic about Anne’s stupid comments, so good for him. I guess libertarians just cannot stomach the idea of government interfering (and in such a hateful way) with people’s weight and appearance.

    Another sarcastic response which I enjoyed, but which isn’t really from a fat acceptance writer, is this:

    A very personal protest against Anne’s disgusting statements:

    A scientist protesting against Milton. She too, seems relatively unaware of fat acceptance (though I’ll have to read her whole blog to understand where she is coming from.):

    Oh, and this Guardian article:

    While there are some really good protest here, in terms of volume it seems disappointing. Maybe I’ve not googled enough. Or maybe many Brits prefer their public debates in their newspapers rather than blogs (there is something honorable in that).

    But what about this theory: British people are subjects – not just subjects of the queen, but of the whole class system, and while we regularly see protests in London, on the whole the British people are too browbeaten by the likes of Anne Milton to come up with a proper backlash against her bullshit.

    I think a good dose of republicanism would help to put fat acceptance in the UK where it should be, and put Anne Milton where she should be (too ashamed to show her face in public).

    • 17 Frances 4 August, 2010 at 12:32 pm

      I don’t know about that. The fat acceptance movement in the UK is certainly a lot older and a lot larger than the one we have in Australia. They’ve got an excellent Fat Studies reader, for one. Charlotte Cooper is based in London and she wrote about this issue.

      Also, I think the fact that people who aren’t involved in the fat acceptance movement took umbrage with Milton is a really positive thing. The British FA movement might actually be making some kind of a difference!

      Re: Brits being submissive subjects – I should point out that Australians are subjects of the queen too and all capitalist societies are subjects of the class system. There are many valid reasons for getting rid of the monarchy but removing fat stigma isn’t one of them.

  13. 18 BuffPuff 4 August, 2010 at 9:17 pm

    Frances, I regret to report that Fat Acceptance barely has a pulse in the UK. The US has a much longer history of organised activism. We had one FA-related conference here in London about 20 years ago, of which I was one of 400 delegates. It was ridiculed in the national news and crashed by the gutter press, (who were fortunately flung out) and was mostly damned good fun, however nothing whatsoever came of it long term.

    @eelt, I found this part of Ruth Sunderland’s Guardian piece very telling:-

    “The prevalent view of health professionals is that calling people fat is insulting, and that using the term “obese” is less of a stigma. I’m not sure about that: obese, to me, suggests more than being just fat, it suggests gargantuan, grotesque, can’t-heave-yourself-onto-a-bar-stool-without-breaking-it fat. People are not said to be obese and jolly, or obese with such a pretty face; they are clinically, or morbidly obese”

    …which further illustrates the point I was making about language. ‘Obese’ may well refer to an arbitrary number on the BMI scale and the public may well be being told reputedly that it’s a fast track to an early death from omgcancerhearttype2diseasediabetes – but, ultimately, its common usage generally equates to “fatter than I can stand to look at or want to shag”. The fact it has a precise medical meaning is, in my opinion, secondary. i.e “Medical science approves of my right to call you rude names and assassinate your character” Whatever you call Fat, in a highly fat phobic culture, will end up becoming an insult in the mouths of those who fear and revile it. Anne Milton, having the Good Sense not to let herself become fat, (owing to her innate sense of Personal Responsibility as opposed to – oh, I dunno – the fact her body type isn’t genetically disposed to becoming fat), hasn’t got a baldy clue.

    • 19 Frances 4 August, 2010 at 10:48 pm

      “it suggests gargantuan, grotesque, can’t-heave-yourself-onto-a-bar-stool-without-breaking-it fat” – GEEEEEEEEZ. Stay classy, Ruth Sunderland.

  14. 20 Desiree 4 August, 2010 at 10:34 pm

    I completely agree with point 2.
    Trying to shame a person about their appearance is cruel, judgemental and utterly pointless.
    Thank you for this convincing discussion xo

  15. 21 eelt 5 August, 2010 at 6:23 am

    Frances, maybe my ‘Brits are subjects’ explanation is poor, but BuffPuff confirmed that fat acceptance activism is weak in Britain, and I think some explanation of this problem is needed.

    I can see that people may give up on changing attitudes in society, because it is not easy, and people get by and somehow live with the prejudice they have to face.

    But when a government politician makes it her business to cause and increase hatred towards a section of the population, and people don’t react really furiously, then something must be wrong.

    I feel there should be loud, non-stop calls for her to resign & apologize, and I can’t understand why that is not happening.

    @BuffPuff: I agree with you about what obese really means to people – I can still remember the way a 19 year old apprentice who works in our office spat out that word just the other day.

  16. 22 maddie 5 August, 2010 at 7:43 am

    Hey Eelt 🙂

    Just thought I would point out that I’m not a *scientist* merely a geeky geek on the road to a healthier life, trying to use methods that work and ignoring the fads. Sorry if you found the blog misleading in any way.

    Part of what angered me so much about Anne Milton’s comments is that I *work* for the NHS…we are being crapped about with so much by this government that this isn’t just a slap in the face of people who tip the BMI scale (and yes, I agree it’s a spectacularly bad and arbitrary one), it’s a slap in the face of everything NHS workers aim for, hope for and aspire to be.

    • 23 eelt 6 August, 2010 at 5:27 am

      No problem, Maddie, I just discovered your blog looking for responses to Anne Milton. I can see you don’t fully accept all the ideas of the fat acceptance movement. That is fine, of course, but maybe in time I’ll get round to leave some comments there at some point.

  17. 24 Tina 6 August, 2010 at 2:23 am

    After having read all this, I am just wondering why anybody should feel entitled to comment on my weight and lifestyle, or even encourage me to adopt another lifestyle. A health professional or any other person with a knowledge of health and weight issues may provide information. I may listen and read, and then decide for myself, but I do not need anybody to shame me into “better” behaviour.

  18. 25 Hidi 6 August, 2010 at 10:08 am

    Go Frances! I totally agree with the list especially #5 about that damn BMI.

  19. 26 Ms. Moran 6 August, 2010 at 12:21 pm

    The word “fat” can, at times, be a positive word. Obese never is. Obese is giving up. Obese is not fit for regular society. I can say “Make room for my fat ass” and it can be funny or endearing.

  20. 27 Rose 15 August, 2010 at 8:03 am

    I would much rather hear someone say I’m overweight than obese or fat.

    • 28 Frances 15 August, 2010 at 4:50 pm

      Many fat bloggers (myself included) have a problem with the term ‘overweight’ because it assumes that there is a weight we should be at. Both ‘overweight’ and ‘obese’ are inextricably linked to the body mass index, which as I mentioned in my post, is an extremely problematic tool to use.

      Why don’t you like the word ‘fat’?

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