What if fat is no better (or worse) than thin? (Reflections on Weight Loss and Weight Loss Surgery, Part 2)

Over the past several years, the characterization of weight loss surgery (WLS) as effortless, coupled with tabloid type coverage of surgery gone wrong, fails to offer any in-depth consideration of WLS as a cultural phenomenon brought about by a collision of factors. The healthcare industry’s limited approach to body size, the practices of loading food with high fructose corn syrup and offering super size portions as the norm, the failure to promote health, nutrition and exercise rather than diet, diet, diet, and, most pertinently, the sanctioning of prejudice enacted upon fat bodies (and especially fat female bodies) in the news, the workplace, and the public arena are just a few of the causes contributing to the growth of WLS.

Not only has the thin-loving media condemned WLS, so have fat acceptance groups and fat activists. Paul McAleer claims such surgeries are done “in the name of fucking vanity” while Kelly Bliss predicts that in the future we will look back on WLS as “comparable to lobotomies.” It is surprising fat activists such as these suggest those opting for surgery only do so for aesthetic reasons on the one hand, and that ‘stupid fat people’ are being duped into surgery on the other. Comments comparing WLS to “fat genocide” or framing WLS as a moral outrage similarly construct the debate in very stark terms – namely, WLS bad, fat good.

However, I don’t think it is any better to claim that fatness is ALWAYS good than to claim that thinness is always good, beautiful, etc. Fat CAN be unhealthy for certain people given their genetics, body frame, and other health factors. Fat is not INHERENTLY unhealthy in and of itself, but so-called morbid obesity (I hate that term) CAN be a health risk. Fat activists and acceptance sites often seem to deny this. But, what if fat is no better (or worse) than thin? Isn’t this notion the goal body liberation groups are trying to reach? That, we need to, as activist Marilyn Wann claims, erase the “line” between fat and thin  – and – in so doing – eradicate “skinny privilege.” If this is truly the goal, condemning the symptoms of body hatred should not be the focus – rather, the CAUSES of this cultural dis-ease with certain types of bodies must be addressed and eradicated.

Further, the insinuation that WLS is done in the main for vanity or conformity reasons fails to account for the fact that health risks are the number one reason people cite for considering (or having) WLS. While I understand that such risks are trumped up and mythologized by an anti-fat medical establishment, I also believe that fat can complicate certain health factors for CERTAIN bodies. Is WLS the answer? Not necessarily. But, acting as if it is NEVER the answer seems myopic. Further, hammering the point that it is risky and can lead to death seems like scare mongering – surgeries are inherently risky, all of them can lead to death… giving birth is risky and can lead to death – should we frame it as comparable to a lobotomy as well? (This rather overstretched analogy is prompted by McAleer’s post that frames WLS as a “moral decision” in relation to reproductive choice/abortion).

Camryn Manheim touches on an important issue related to what seems like the conditional acceptance in the fat acceptance movement. In Wake Up, I’m Fat, she notes her discovery of the plethora of fat acceptance organizations and magazines, sharing her dismay with trying to find a potential partner in the personals sections of such publications. Revealing fat as a sexual commodity in such magazines, she laments that “In this world of ‘size acceptance,’ my fat was all that mattered; the other stuff was apparently irrelevant” and bemoans that the ads are not based on “size acceptance but ‘size insistence'” (Manheim 1999, p.121 and 123). To a degree, this observation can be extended to the fat acceptance movement. If you are not fat, or not ‘fat enough,’ or have lost your fat, you are suspect to insinuations of cultural conformity and ‘giving in.’ This is why I now tend to favor “body acceptance” or “body positive” or “healthy at any size” or “body liberation” rather than the phrase “fat acceptance” as I feel ALL bodies – not only fat ones – deserve acceptance.

Protesting WLS by marketing anti-surgery products on the web and staging anti-surgery demonstrations, fat activist Marilyn Wann is in line with this view of WLS as acquiescence to cultural conformity. Noting a future issue of her zine Fat!So? will be about “how silly weight loss surgery is,” Wann says “I think the most powerful force for change in our society is public ridicule.” Wann describes her plan “to ridicule the idea that cutting off the healthy stomach of a human being is ever a good idea,” noting she will enact this plan “without ridiculing actual people” How, in fact, is such supposedly well meaning ridicule possible?  Rather than the ego-deflating practice of ridiculing, which fat people already suffer on a daily basis, how about devoting energy to examining the widespread causes that have made WLS such a widespread cultural phenomenon in the first place? For, while questioning the validity of surgery as an option is certainly laudable, condemning surgery on all counts seems narrow-minded. Such a blanket condemnation seems to go against the very message such organizations preach – namely, diversity, acceptance, cultural awareness, and extended analysis of the deep-seated causes of fat phobia.

And, while size acceptance groups roundly condemn the surgery, the very media that exhorts us to be thin at all costs, that sends us thousands of daily messages conveying only thin bodies are beautiful, also chastises those who attempt to live up to inane standards via surgical means.  Survive on liquid protein (ala Oprah), exercise so fanatically that even post-pregnancy you’re stick thin (ala Demi Moore), or opt for drugs instead of food (ala heroin chic) and you are a fat fighting hero. But, opt for surgery, well, you’re a brainless lazy schmuck with zero will.

Even more ironic is the MSMs relative approval of the fat sucking procedure know as liposuction (as extolled on shows such as Extreme Makeover and The Swan). If this surgical option is ok, why isn’t WLS?  Hmmm, could it be that those who opt for liposuction are usually only curvaceous with plump thighs or tummies that they must get rid of in order to morph into Kate Moss? In contrast, the bodies who undergo weight loss surgery are for the most part upwards of 250 pounds. They are the bodies paraded on talk shows as freakish, the ones inspiring bumper stickers like No Fat Chicks!, the ones no one wants to sit next to on an airplane, the ones constantly exhorted by ‘well-meaning’ friends, family, and strangers to diet. Often, they do, creating a cycle of loss and gain and ending up with far more health and esteem problems than if they had accepted themselves in the first place. These bodies, rejected by culture, mocked by the media, and scorned by the general public now have yet another burden to add to their vilified existence if they opt for WLS – now they are also too lazy to do it the hard way (as Oprah suggests), too weak to exercise self control (as Maher jokes, characterizing the surgery as “willpower bypass”), too cowardly to refuse conformity (as fat activists propose).

The many before and after shots lauding post-surgical success stories may make it seem the media have embraced this phenomenon. But a closer look reveals an emphasis on extreme risk, deprivation, pain, and, horror of horrors, post-op saggy skin. And, predictably, the stories focus on female bodies. As with shows such as The Swan, where ‘ugly duckling’ female contestants undergo extensive surgical and diet procedures to become ‘beautiful swans,’ it is still the female body that is under strict cultural surveillance to be attractive (read thin) at any cost. These stories are told not to celebrate let alone analyze this latest trend in our never-ending futile fight against fat – rather, they are the newest form of the fat body as freak show entertainment, proclaiming: “Come one, come all! Feast your eyes on a former fatty!” Oddly enough, the fat acceptance movement seems in league with the media in that it also frames those opting for WLS as freaks – or, as lobotomized morons with amputated stomachs… What if instead, we saw fat as no better or worse than thin?

12 thoughts on “What if fat is no better (or worse) than thin? (Reflections on Weight Loss and Weight Loss Surgery, Part 2)”

  1. Again, I guess I’m missing the media backlash against surgery. Diets are still very much in, but I think WLS is, too. It’s certainly touted in the medical community.

    I googled a couple news organization names, plus weight loss surgery, and found:
    ABC: Upbeat story about woman attempting brain surgery to lose weight. She’d tried gastric band, and it hadn’t work long-term. (Shocker.)
    CNN: Article on natural orifice surgery *shudder* that ignored diet until the last, obligatory line about not continuing to eat doritos and apple juice. Second article is compeltely laudatory “Surgery helps woman drop 135 pounds, 10 dress sizes.” No mention of deprivation, even in the last quote, which is usually reserved for an “opposite view” closer.
    CBS: Article that touts the safety and efficacy of WLS, claiming it ends diabetes, apnea, food cravings, and interviewing people who are now happy and have lost lots of weight.

    So I guess I’m not understanding your contention that the media generally views WLS as a cop-out. There’s no examples of people who have done the same with diet, or emphasis that this is a last resort for people who can’t abide by, say, a liquid fast.

    Oddly enough, the fat acceptance movement seems in league with the media in that it also frames those opting for WLS as freaks – or, as lobotomized morons with amputated stomachs…

    Umm. What I’ve seen in fat-loss circles is a frustration with doctors who don’t warn patients about the side effects – which *ought* to be emphasized, considering how debilitating they can be. I think there’s general sympathy with people who are getting the surgery because they’ve been told they’re OMG!fat and GOING TO DIE, and irritation that some less-scared people are willing to accept long-term malnutrition, vomiting, and likely severe complications to be thinner. Again, some links or examples of what you mean would be incredibly helpful.

  2. Well, I suppose I should have articulated that this was a piece I wrote several years ago during the entire Al Roker/Carnie Wilson WLS media saturation. At that time, most of the focus, especially in entertainment news media (People Magazine, Entertainment Tonight, etc), seemed rather ‘freak show’ and derogatory.

    I am intrigued to hear there has been a shift and you have encouraged me to look further into this. Thanks! But, in terms of stories of people who have done the same w/ diet, see People magazine which runs such stories frequently — with the obligatory before and after photos of course. Isn’t Biggest Loser also doing this?

    The links to some of the more well known fat activists (Wann/McAleer) are evidence of the type of framing I am talking about. Big Fat Blog, for instance, seems to frame WLS in the ways this post explores — not so much as the frustration you mention, but as “fat genocide.” While the complications you mention (“long-term malnutrition, vomiting, and likely severe complications”) occur, I would like to know how often. The stats on this vary widely… Some pro-wls arenas claim complications are rare while body acceptance arenas claim they are rampant. The stats are so divergent, it is hard to know where the actual numbers lie…

  3. And it could well be that “softer” news (although that line is blurring) and entertainment focused news is harder on WLS. I dodge People as much as possible, so I admit I’m not so up on that type of article.

    I also admit I’m more willing to believe the downsides to surgery – not only because I think fat is overmedicalized, but also because it’s hard for me to believe that surgical starvation could be side-effectless. My understanding is that most (~70%) of patients experience extended periods of vomiting while they figure out how to eat, and their body adjusts, and depending on how the surgery is performed and how vitamins/protein is administered, serious issues (anemia, for example) crop up in 10-15% of patients. That is not an insignificant number, but it’s perfectly possible that management has improved since I looked at the numbers.

    As for the studies/science, I generally turn to Junk Food Science, which has a similar bent. However, I do think Sandy is a careful, thorough reader, and I usually read the studies she cites to better get a handle on the study organization/data manipulation. She’s got a bariatric series in her sidebar (all worth reading), but the ones that strike home to me are her examination of bariatric death rates and some of the issues with the studies of mortality:
    http://junkfoodscience.blogspot.com/2007/10/jfs-special-latest-research-on-actual.html

    http://junkfoodscience.blogspot.com/2007/01/junkfood-science-weekend-special.html

    It’s easy for me to imagine that patients with complications have a difficult time speaking out, particularly since the immediate social effects of weight loss are tons of compliments and praise. It’s also indelicate to discuss some of the complications with strangers or co-workers.

  4. If I may comment on “size acceptance” versus “fat acceptance”, I think you make really valid points, but in a society where fat is demonized, pathologized, etc., I think it is important to take a stand “for fat” if that makes any sense.

    Absolutely, what is healthy for any single body is going to be very different and unique, and fat CAN be unhealthy as can any other body shape. But it is fat that seems to be most scrutinized. (Although I certainly have empathy for those individuals who are thinner in stature and are thus assumed to have eating disorders, etc.)

    The fact is is that even when fat is unhealthy for a person, fat phobia only makes it worse. I would rather a person make peace with their body size first, Because beating them over the head with “you are unhealthy!” is cruel. But I am preaching to the choir here.

  5. I feel there’s a similar polarization over psychiatric drugs, which are sometimes demonized to the extent that people who could really benefit from them are either turned off or deprived access by other people.

    I’m not familiar with WLS, but I think you make a VERY important point that NOT ALL KINDS OF FAT BODIES ARE UNHEALTHY. I’m not a fan of those height-weight-body fat percentage charts at all.

    Christina

  6. Onely,
    Good linkage to the whole to drug or not to drug debate. Sheesh, as a people, we so readily condemn and judge. What works for some will not work for others — seems like such a simple concept, yet we can’t seem to live by it.

  7. Stats for WLS patients are only kept for those patients who keep visiting for aftercare. No one records what happens for those who don’t follow up. If a WLS isn’t losing weight they are unlikely to go back to their practitioner (who would undoubtedly blame the patient because, you know, a medical procedure could never not work). Many other side effects of WLS can be documented as stemming from other issues, for example gall bladder surgery. A lot of WLS end up needing their gall bladder removed after their WLS because sudden weight loss can cause flare ups. I doubt that would be documented as a consequence of WLS by the medical profession. I don’t think WLS is an easy option. I also don’t condemn those individuals who undertake such a desperate procedure. I don’t think it is a good thing to do but I can understand why some fat people would see it as their only option. I wish society hadn’t convinced them it was preferable to undertake WLS in order to (try to) be thin, I wish society accepted and embraced individuals in all our diversity.

  8. onely,

    I absolutely agree re: the polarization of psychiatric medication. While I certainly have big problems with the way in which psychiatric meds are often tested, prescribed, and sold (and I blame this, personally, on capitalism), I take issue when people take a judgmental attitude towards people who use and need these medications.

    The fact is is that these meds can and do help people. And I get really frustrated that instead of critiquing the way in which society treats mental health and people with mental health diagnoses, people who use psychiatric meds are often “on trial”.

    I support people’s rights to make informed decisions about their bodies, including decisions I myself may not agree with. I believe, however, a lot of the time decisions are not fully informed, not because the people making the decisions are “ignorant” but because they aren’t given all the information.

    I work in the mental health field and have seen psychiatric meds and other treatment be very successful and empowering. And I have seen it go the other way. I believe demonizing either side (the polarization that you describe) blames the wrong people and renders invisible the diverse experiences of people with mental health diagnoses.

    The field of “weight loss” is full of blame for people who are defined as fat. And instead of focusing on questioning unrealistic and unnatural body types (in that everyone’s body looks differently, but we are all expected to look a particular way), we like to blame fat people, both for not doing drastic measures such as WLS and for doing it.

    Capitalism requires this demonization and polarization, whether it is in regards to mental health and treatment, or weight loss.

  9. I just read a blog that commented on the lack of fat people on Star Trek (the latest movie). In my admiration of Spock’s eyebrows and frustration at the impractical mini skirts women Star Fleet staff had to wear (which serve no function other than being eye candy), I completely missed this.

    I remember being told as a child by a Star Trek obsessed mother (who always asserted she would rather live on the holodeck) that in the Star Trek world, they had cured cancer, AIDs, and fatness. Interesting (and sad) that she lumped a body size/shape into the category of illness. And even sadder that fatness was something that had to be “cured”.

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