matters. 97
Gaesser heavily cites Steven Blair, who is professor of exercise science and has published scores of peer-review articles in leading scientific journals including the Journal of the American Medical Association ( JAMA ) showing that physical fitness better predicts health outcomes than BMI. In fact, Blair’s work has shown that, among people with the same level of physical fitness, BMI has no effect on mortality from all causes. 98 Blair says that he believes that “obesity travels in bad company,” in that it is associated with higher rates of diabetes, heart disease, and knee osteoarthritis, but that obesity itself is “the wrong target” of health interventions. The target, he says, “should be on lifestyle,” including a “healthful diet and regular physical activity.” He expresses frustration with the disproportionate focus on energy intake and relative inattention to physical expenditure in the literature on obesity and is adamant that “it’s inexcusable now for scientists to study obesity and not to take physical activity, carefully measured or cardiorespiratory fitness, into account.”
A family nurse practitioner and member of NAAFA talks about how she brings a health at every size frame to bear on her clinical practice: “I never tell my patients to lose weight. I think that it’s a horrible thing to tell people: ‘Oh, you have to lose weight.’ I do encourage my patients strongly to make healthy choices in eating, and I try to encourage them to exercise, because I really do believe that you can be fat and you can be fit.” While a medical frame likens fat to cancer and smoking and a public health crisis frame likens fat to an epidemic, according to a health at every size frame, fat itself is largely irrelevant to health. Espousing this perspective, political scientist Eric Oliver argues that the connection between fat and cardiovascular disease may be the same as the connection between yellow teeth and lung cancer: “Based on our current evidence, blaming obesity for heart disease, cancer, or many other ailments is like blaming smelly clothes, yellow teeth, or bad breath for lung cancer instead of cigarettes; it conflates an associated trait with its underlying cause.” 99 As far as I know, Oliver is the only one to compare fatness to yellow teeth. However, this analogy is consistent with what could be called a HAES mantra: association does not equal causation.
Nutritionist Linda Bacon likens fatness to baldness to make the same point in Health at Every Size : “It is well established through epidemiological research that bald men have a higher incidence of heart disease than men with a full head of hair. However, this doesn’t mean that baldness promotes heart disease or that hair protects against heart disease. Nor is it recommended that bald men try to grow hair or buy toupees in order to lessen their disease risk. Instead, further research indicates that high levels of testosterone may promote both baldness and heart disease.” 100 While fat is likened to yellow teeth and baldness to make a specific point about association versus causation, it is nonetheless revealing that neither yellow teeth nor baldness are especially positive characteristics. While strongly disputing that fatness is, in and of itself, a risk factor and or disease, the health at every size frame does not offer an alternative positive interpretation of fat. The health at every size frame does not assert that fat is beautiful or that fat is necessarily healthy. Rather it makes a weaker claim: that one can be fat and healthy, just as one can be thin and unhealthy. It neutralizes, without inverting the stigma associated with fatness. 101
ASDAH is most associated with a HAES approach and now possesses the official Health at Every Size trademark. Founded in 2003, ASDAH is, according to their official website, “an international professional organization composed of individual members who are committed to the
Gaesser heavily cites Steven Blair, who is professor of exercise science and has published scores of peer-review articles in leading scientific journals including the Journal of the American Medical Association ( JAMA ) showing that physical fitness better predicts health outcomes than BMI. In fact, Blair’s work has shown that, among people with the same level of physical fitness, BMI has no effect on mortality from all causes. 98 Blair says that he believes that “obesity travels in bad company,” in that it is associated with higher rates of diabetes, heart disease, and knee osteoarthritis, but that obesity itself is “the wrong target” of health interventions. The target, he says, “should be on lifestyle,” including a “healthful diet and regular physical activity.” He expresses frustration with the disproportionate focus on energy intake and relative inattention to physical expenditure in the literature on obesity and is adamant that “it’s inexcusable now for scientists to study obesity and not to take physical activity, carefully measured or cardiorespiratory fitness, into account.”
A family nurse practitioner and member of NAAFA talks about how she brings a health at every size frame to bear on her clinical practice: “I never tell my patients to lose weight. I think that it’s a horrible thing to tell people: ‘Oh, you have to lose weight.’ I do encourage my patients strongly to make healthy choices in eating, and I try to encourage them to exercise, because I really do believe that you can be fat and you can be fit.” While a medical frame likens fat to cancer and smoking and a public health crisis frame likens fat to an epidemic, according to a health at every size frame, fat itself is largely irrelevant to health. Espousing this perspective, political scientist Eric Oliver argues that the connection between fat and cardiovascular disease may be the same as the connection between yellow teeth and lung cancer: “Based on our current evidence, blaming obesity for heart disease, cancer, or many other ailments is like blaming smelly clothes, yellow teeth, or bad breath for lung cancer instead of cigarettes; it conflates an associated trait with its underlying cause.” 99 As far as I know, Oliver is the only one to compare fatness to yellow teeth. However, this analogy is consistent with what could be called a HAES mantra: association does not equal causation.
Nutritionist Linda Bacon likens fatness to baldness to make the same point in Health at Every Size : “It is well established through epidemiological research that bald men have a higher incidence of heart disease than men with a full head of hair. However, this doesn’t mean that baldness promotes heart disease or that hair protects against heart disease. Nor is it recommended that bald men try to grow hair or buy toupees in order to lessen their disease risk. Instead, further research indicates that high levels of testosterone may promote both baldness and heart disease.” 100 While fat is likened to yellow teeth and baldness to make a specific point about association versus causation, it is nonetheless revealing that neither yellow teeth nor baldness are especially positive characteristics. While strongly disputing that fatness is, in and of itself, a risk factor and or disease, the health at every size frame does not offer an alternative positive interpretation of fat. The health at every size frame does not assert that fat is beautiful or that fat is necessarily healthy. Rather it makes a weaker claim: that one can be fat and healthy, just as one can be thin and unhealthy. It neutralizes, without inverting the stigma associated with fatness. 101
ASDAH is most associated with a HAES approach and now possesses the official Health at Every Size trademark. Founded in 2003, ASDAH is, according to their official website, “an international professional organization composed of individual members who are committed to the
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