Is Being Fat a Choice?

Body Positivity ≠ Fat Acceptance

Foreword

After the overwhelming popularity of Getting Jacked is Simple, many subscribers requested a similar science-based investigation into the dieting and bodyfat % component. The people have spoken! Who am I not to give them what they want?

While putting this article together, however, I realized that there is a rather prominent and ongoing cultural conversation to consider: whether or not being fat is largely genetic, how unhealthy it really is, and to what extent fat shaming is a problem in our society, are all topics being actively debated.

For example,

Mikala Jamison

is a balanced writer who promotes body positivity amidst a healthy lifestyle. In her recent article, If you’ve never been fat, you just don’t get it, she quotes plus-sized influencer Remi Bader’s experience with trying to lose weight:

“But I also started getting backlash from the body-positive community,” Remi said.

“…certain people in the plus-size community aren’t on my side is because I will openly talk about being unhappy with my body. When I say, ‘I’m not the happiest right now,’ or ‘I don’t feel great,’ people will say ‘Remi’s fatphobic.’ But I’ve gained probably 80 pounds over the past few years. I’m only 27 and I’m getting a lot of health problems.”

Surely, we should not be discouraging people who are worried about their health and wanting to take measures to improve it!? Is doing so really fatphobic?

I think most of us use how healthy a behavior is as a quick heuristic for judgement. A skinny K-pop star succumbing to social pressure and developing anorexia seems bad, and an intervention of body positivity seems good. But someone who is 80 pounds overweight at the age of 27 deciding to lose weight seems good, and if the body positivity movement condemns that, well… it seems kinda bad.

The plus-size community absolutely does not consist of only people who shout ‘fatphobic’ at any mention of a desire for weight loss. Nonetheless, as my research continued, I realized that the ‘fat acceptance movement’ or ‘fat activism’ is actually fairly widespread. There is in fact a large contingency within the body positivity movement that believes there’s nothing wrong with being fat, that there is limited health risk associated with obesity, that your weight is mostly a function of genetics, and that any pressure to lose weight is a form of bullying.

This article will serve as a scientific investigation into these claims, setting the stage for an upcoming post concerning the optimal strategy for losing weight.

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TLDR

• Many of the goals of the body positivity movement are admirable, but ‘fat acceptance’ is not one of them. We should be able to support body positivity while drawing the line at extremely unhealthy behavior. Just as society does not praise smoking or alcoholism, neither should it praise morbid obesity

• “Calories in, calories out” explains the vast majority of outcomes. It is difficult to precisely measure either side of the formula, but precise measurement is not necessary to see health benefits

• Being fat is a choice for the overwhelming majority of us. It is true that it is more challenging for some people to regulate their weight than others due to environmental, psychological, and genetic factors, and increasing awareness of this is good- but just like alcoholism, we still consider being fat a choice. If you need help, ask for help- from doctors, friends, spouses- but ‘letting yourself go’ is a choice

• Being fat is unhealthy! Obesity is a very strong predictor of overall health. It’s associated with a wide range of comorbidities, including cardiovascular disease, diabetes, respiratory problems, joint problems, kidney problems, and mental illness. Every medical organization in the world comes down strongly on the side of obesity being unhealthy

• Fat shaming is ineffective. The psychological damage of the stigmatization and bullying is so great that it can be counterproductive and push individuals further into unhealthy habits. Raising awareness about obesity without stigmatizing the obese is a far more effective approach

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Body Positivity

The body positivity movement has many admirable goals. They include:

• Fostering appreciation for different body types

• Challenging harmful and unrealistic beauty standards

• Promoting self-love and acceptance

I wholeheartedly support these aims and believe that they will make people happier and society better off. But I also believe we can pursue these goals without abandoning any and all ties to science.

A young woman who grows up with positive representations of her body type in the media is less likely to develop self-esteem issues, and that’s fantastic- but being morbidly obese is not a ‘body type’. Body type differences exist, truly, but in reference specifically to immutable differences like bone structure and muscle and fat distribution.¹ It is absolutely true that some people distribute fat more in their stomach, and therefore ‘look’ fatter despite being at a healthy weight- and that is the type of body difference we should promote awareness and acceptance of. But celebrating actual obesity is not body positivity; it is celebrating giving up.

For this reason, it is discouraging to see so-called fat activism often presented side by side with body positivity. I can’t help but shake my head in disbelief at the arguments being put forth by these activists. They broadly fall into 3 camps, with frequent overlap between the first two:²

1. Being fat isn’t a choice, so stop shaming people for what they can’t control

2. Even if being fat is a choice, it’s not inherently unhealthy or otherwise wrong

3. Being fat is mostly a choice and a bad one, but shaming people is counterproductive and should be replaced with a more kind and holistic approach

In this article I argue that camp 1 is willfully ignorant, camp 2 is scientifically illiterate, and that camp 3 is full of reasonable people that get a bad rap by association with camps 1 and 2. I will also present the fatphobic argument, which differs from camp 3 only materially in response to whether or not fat shaming should be condemned.

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Defining Fat Activism

First, a neutral definition to work with, courtesy of Wikipedia:³

The fat acceptance movement (also known by various other names, such as fat pride, fat empowerment, fat liberation, and fat activism) is a social movement which seeks to eliminate the social stigma of obesity.

The largest and longest-running organization pursuing this goal is NAAFA (the National Association for the Advance of Fat Acceptance). Their home page welcomes visitors with a short pitch:⁴

At least one-third of the world’s population is fat, yet fat people are discriminated against in all aspects of daily life. For over 50 years, NAAFA has worked to make the world a better place for fat people through education, advocacy, and support. We are a multigenerational, intersectional social justice organization creating opportunity for big bodied people and building community for fat people and our loved ones. Our work towards #EqualityAtEverySize is changing the world!

They are currently working on the “Campaign for Size Freedom”, in partnership with Dove.

All bodies deserve care, love and respect. We want to be compensated fairly for our work, receive high-quality medical care, and be welcomed in all public spaces. For people of larger size, that is not the current reality. Very few laws exist that specifically outlaw discrimination based on body size.

And their blog currently looks like this:

This is undeniably a straightforward and fair representation of the views and activity of the fat acceptance movement.

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The Statistics

Before we dive into the arguments, here are some simple facts from the CDC:⁵

1. Americans are fat. 42% of adults are obese (BMI > 30) and 9% are severely obese (BMI > 40).

2. Americans are fatter now than ever before. The figures above are a 12% increase in obesity and 5% increase in severe obesity from the same data in the year 2000.

3. Being fat is expensive for both patients and the health care system. Obese adults incur nearly $2,000 higher annual medical costs than the non-obese

4. Being fat is associated with other serious chronic diseases. 58% of obese adults have high blood pressure and 23% have diabetes (vs 48% and 12% in general population).⁶⁷

Note that the CDC is not a mean spirited organization- in fact they are highly sensitive to how these statistics may come across. On the page cited above, and on many of their other pages, they include the below disclaimer.

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The Fatphobic Argument

The fatphobic argument is simple and straightforward.

1. A healthy society is desirable

2. Being fat is unhealthy

3. Therefore, a fatter society is undesirable

4. Social acceptance of fatness leads to a fatter society

5. Therefore, being fat should have negative connotations

Most people intuitively follow this logic, especially in cases where it is easy to imagine children growing up thinking an undesirable behavior is ‘okay’ and becoming more likely to engage in it themselves. For instance, the exact same argument is made about cigarettes, and nearly everyone agrees with it:

1. A healthy society is desirable

2. Smoking cigarettes is unhealthy

3. Therefore, a society that smokes is undesirable

4. Social acceptance of smoking leads to more smokers

5. Therefore, smoking should have negative connotations

The popularity of smoking peaked immediately after the 1964 Surgeon General's Report on Smoking and Health, a landmark report that officially established the definitive link between smoking and various health risks.⁸ Society began to change in the aftermath and never looked back.⁹

Why should being fat be any different from smoking? It should be our right to do either if we wish- but neither should be celebrated. Freedom of speech does not mean freedom of judgement.

We know that being fat is unhealthy, we know that obesity most commonly begins in young children or in adolescents, we know that children of obese adults are far more likely to become obese themselves, and we know that at current trends as much as 50% of all American children today will be obese in adulthood!¹⁰ Obesity is unhealthy, should not be celebrated, and it would be better for both fat individuals and society if it were less common.

What About Fat Shaming?

So, we’ve established the central case of the fatphobic view. However, fatphobia is also associated with fat shaming- surely this is just mean-spirited bullying and can’t be condoned, right?

Well, the fatphobic view is that shame is a useful societal tool to encourage conformity to shared values.¹¹

The oldest explanations of human behavior are moral, not social; and one of the oldest forms of moral exhortation mobilizes the emotion of shame… unavoidably a social emotion. Shame operates in terms of a supposition of another's regard for self, of taking on the view of another. In this way, shame pulls those who experience it in line with social expectations.

In other words, shaming people for undesirable social attributes and behavior, including smoking cigarettes, drunk driving, or yes, being fat, has a social purpose- to suppress that activity.

So fat shaming, in theory, could work. The questions to answer are:

1. Does fat shaming work to reduce the rate of obesity?

2. Even if it does work, do the physical benefits of lower obesity outweigh the mental costs of bullying?

The only significant disagreement between the fatphobic view and Camp 3 is that the fatphobic think the answers to both questions are ‘yes’, and Camp 3 thinks the answers are ‘no’. We’ll return in the section on Camp 3 to see which side has the better evidence.

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The Fat Acceptance Argument

The fat acceptance argument can be split into 3 camps:

1. Being fat isn’t a choice, so stop shaming people for what they can’t control

2. Even if being fat is a choice, it’s not inherently unhealthy or otherwise wrong

3. Being fat is mostly a choice and a bad one, but shaming people is counterproductive and should be replaced with a more kind and holistic approach

Aubrey Gordon is a well-known modern fat acceptance activist in both Camp 1 and Camp 2. In her book You Just Need to Lose Weight, she makes the following claims (paraphrased) which I will use to represent these camps:

Camp 1: Fat people face professional and social discrimination. If it was in their ability to change this, they would. More important than willpower are factors like your genetics, environment, and financial means.

Camp 2: Being fat is not at all or only loosely associated with health risks. Thin people can be unhealthy; fat people can be healthy. Most weight loss efforts fail long-term and can cause worse problems. Health interventions should instead focus on better behaviors such as nutritional focus, joyful movement, stress reduction.

Let’s review the scientific literature to assess these claims.

Camp 1- Being Fat is Not a Choice

Aubrey says:

“Our bodies are not simply the product of personal choice. They are shaped by genetics, environment, and systems far larger than our own willpower.”

“We act like being fat is a moral failure, as if it’s the inevitable result of laziness or gluttony. But fatness is not a choice- it’s a natural human variation.”

Aubrey argues on behalf of Camp 1 that an implicit assumption of point #4 of the fatphobic view (Social acceptance of fatness leads to a fatter society) and point #5 (Therefore, being fat should have negative connotations) is that being fat is a choice. If it isn’t a choice, then no behavior will change as a result of shaming it. And if we can’t shame it away, then we should embrace it along with the other admirable goals of the body positivity movement.

This seems like it would be a valid point, if correct. So, is Aubrey correct? Is being fat a choice?

Firstly, it is a fact that one’s caloric surplus or deficit ultimately explains all non-water related changes in body mass- remember that energy cannot be created or destroyed, only transformed. Now, some fat activists have attacked this “calories in, calories out” model as being outdated. Usually, they focus on a few points such as nutritional labels having a 20% margin of error (so you can’t even reliably measure exactly how much calories you are consuming)¹², varying and unknown base metabolic rates for each individual, and the fact that some foods are absorbed differently than others.¹³

These are legitimate concerns about the practicality of measurement, but activists go way too far with the implication that because it’s difficult to count calories, it’s useless. The bodybuilding community has been successfully tracking calories (and macronutrients) to go on periodic bulking and cutting cycles for decades. They set out with the intent to gain or lose weight, set calorie goals, log those calories, and then observe very similar results to their expectations.¹⁴ Fatness arises from consistent calorie surpluses, which are related to choices regarding diet (calories in) and exercise (calories out). Eating fruit is more filling than candy, mostly because of the fiber content, and so it stands to reason that someone who only eats candy will accidentally consume more energy, store more energy, and get fatter than someone who eats fruit. Pretty straight forward.¹⁵

However, the story is not quite so simple. There are environmental factors, such as candy being cheaper than fruit, which may make it harder for lower income people to have a healthy diet. There are psychological factors, such as elevated stress levels (which increases appetite), differences in dopamine pathways which can make some people more sensitive to the rewarding effect of food, and even childhood trauma that can lead to habitual overeating. There are also genetic factors, including being predisposed to store fat more efficiently, have faster metabolisms that burn more calories while at rest, and hormonal differences that affect the feeling of hunger and fullness.¹⁶

But nearly everything in life is a combination of environmental, psychological, and genetic effects! I could write almost the exact same paragraph about people’s susceptibility to alcohol addiction, but does that mean that we simply accept alcoholics as having no choice in the matter? Of course not. Choices were made. Nobody is saying they were easy choices, but choices they were.¹⁷

But Aubrey takes the kernel of truth that it’s harder to maintain a healthy weight for some people than others and really runs away with it to argue that our own choices almost don’t matter at all- which is absolutely not supported by the science.

Note- there are several medical conditions that are also associated with obesity. Hypothyroidism (an underactive thyroid) can result in a reduced metabolism that burns less calories, increased calorie storing, and even disrupt the body’s normal satiety signaling so you feel less full after a meal. About 10% of the population has this treatable condition, which is the most common medical condition with a causal relationship to obesity.¹⁸

Camp 2- There’s Nothing Wrong with Being Fat

Aubrey says:

“Fatness, in and of itself, is not a disease. Some fat people are healthy, some are not- just as some thin people are healthy, and some are not.”

“We have been told for so long that fat equals unhealthy that it can feel like heresy to say otherwise. But health cannot be diagnosed by looking at someone’s body size.”

“My fatness is not shorthand for my medical chart. You cannot know my blood pressure, my blood sugar, or my cholesterol by looking at me.”

Here she argues on behalf of Camp 2 that point #2 of the fatphobic view (Being fat is unhealthy) is simply incorrect. If being fat in fact does not have any associated health risks, then it is wrong to judge fat people and to pressure them to change their lives when they aren’t hurting themselves, let alone anyone else.

This would be a valid point if true, so… is it?

Aubrey seems to be saying something like: “You’re making a generalization that all fat people are unhealthy. Plenty of fat people are healthier than skinny people.” Which is absolutely true but is really just pointing out that there are always outliers in any trend- it doesn’t say anything at all about whether the trend is valid or not! It’s like saying “you’re making a generalization that smokers have unhealthy lungs. Plenty of smokers have healthier lungs than non-smokers!”

I mean, yes, sure- but the question we actually want to answer is: all else equal, is a person likely to be more or less healthy as they get fat or pick up smoking? And the answer is obviously that they get less healthy! The science overwhelmingly supports this. That being fat is unhealthy has about as unanimous support as the law of gravity. Nearly every publication, journal, and organization maintains the view that obesity is associated with significant health risks.¹⁹

“Obesity is a common, serious, and costly chronic disease. People who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions, including type 2 diabetes, heart disease, stroke, and some cancers.”

—Centers for Disease Control and Prevention

“Obesity is a major risk factor for noncommunicable diseases such as cardiovascular disease, diabetes, musculoskeletal disorders, and some cancers. The risk for these noncommunicable diseases increases with increases in BMI.”

—World Health Organization

“Overweight and obesity substantially increase the risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers.”

—National Institutes of Health

“Obesity is associated with an increased risk of developing many health problems, including high blood pressure, high cholesterol, type 2 diabetes, coronary heart disease, and premature death.”

—American Heart Association

And the harmful effects of obesity don’t stop there- there’s also elevated risk of mental illness! Here’s the American Heart Association:²⁰

Research shows obesity impacts brain health from childhood well into adulthood, affecting everything from executive function skills – the complex ability to initiate, plan and carry out tasks – to substantially raising dementia risk. By middle age, the consequences of excess weight are substantial. Several studies have shown middle-aged adults who have a body mass index (BMI) at or above 30, which qualifies as obesity, are more likely to get dementia than their healthy-weight peers.

Being fat is categorically unhealthy!

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Camp 3- Being Fat isn’t Good but Fat Shaming isn’t Effective

Camp 3 follows the fatphobic argument almost all the way to the end. They believe that being fat is a choice, that it is unhealthy, and that increasing rates of obesity are bad for society- but also think that fat shaming is counterproductive and that a kind and holistic approach is necessary to solve the obesity epidemic.

This is the most valid point of all. It matches with all the research we’ve discussed so far, is intuitively plausible, and strikes a great balance between practicality and politeness. So, what does the science say?

The science pretty resolutely comes down on the side of Camp 3. Fat shaming does not work!

There is widespread agreement among public health experts that fat shaming is a harmful and ineffective strategy for improving health. In fact, some studies suggest that fat shaming can cause such psychological damage that it can make individuals even more susceptible to obesity!²¹ Major organizations including the NIH, CDC, WHO, and the American Psychological Association explicitly discourage stigma-based approaches, arguing that they can worsen both physical and mental well-being.²²

Instead, they recommend supportive interventions free of any stigma that emphasize access to nutritious foods, safe and inclusive environments for physical activity, and healthcare focused on behaviors rather than the weight itself. To Aubrey’s credit, even though she is strongly against any negative connotations associated with being fat, she does support focusing on healthy behavior such as exercise and balanced meals rather than an obsession with calorie counting. And she is correct that this approach tends to achieve more sustainable outcomes than programs that focus specifically on dieting and watching the scale.²³

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Conclusion

Camp 3 is the winning argument: being fat is mostly a choice, and a very unhealthy one- but shaming people is counterproductive. Obesity should not be categorically accepted as part of the otherwise admirable body positivity movement, but neither should it define people. Fat shaming should be replaced with a more kind and holistic approach that emphasizes healthy behaviors rather than exact numbers on a scale. Compassionate outreach and support can save lives, but turning a blind eye in the name of politeness will certainly lose them.

1. Determinants of body fat distribution

2. The Fat Acceptance Scale: Development and Initial Validation

3. Fat acceptance movement

4. Why NAAFA?

5. Adult Obesity Facts

6. High Blood Pressure Facts

7. National Diabetes Statistics Report

8. The 1964 Report on Smoking and Health

9. The Health Consequences of Smoking—50 Years of Progress:

10. Obesity In Children And Teens

11. Conformity and shame

12. Food Label Accuracy of Common Snack Foods

13. It's time to bust the 'calories in, calories out' weight-loss myth

14. “Bulking and cutting” among a national sample

15. Body Composition: The Role of Macronutrient Composition – A Narrative Review

16. Predicting Polygenic Obesity Using Genetic Information

17. Genetics and Alcoholism: Is Alcoholism Genetic or Hereditary?

18. Hypothyroidism and obesity: An intriguing link

19. There’s No Such Thing as “Healthy Obesity”

20. Obesity harms brain health throughout life

21. Fat shaming is making people sicker and heavier

22. Overcoming Stigma and Bias in Obesity Management

23. Weight bias and obesity stigma