Who is Actually Advocating for Fat People’s Health?
Image description: A photograph of a patient and doctor conversing, both of whom are white women. The patient is wearing a purple zippered sweater and darker purple leggings, her hair is teal with purple streaks and she is looking at the doctor with a smile. The doctor is wearing a white lab coat and gray slacks with a stethoscope around her neck as well as eyeglasses and a wrist watch. Her hair is short gray and she is holding a black binder and is looking at the patient with a smile.
By Tigress Osborn, NAAFA Executive Director
CONTENT WARNING: Information mentioned below, especially other articles that are referred to, may use stigmatizing language, specifially the O-word. Please see the author’s note at the end of the article for additional thoughts on this.
When it comes to advocating for fat people, NAAFA’s reason for doing so is simple – fat people deserve the same care and respect as everyone else. Our mission to change perceptions of fat and to eliminate size discrimination through education, advocacy, and support extends to all areas of life.
That mission does not explicitly name physical or mental health, and people– both fat people and our critics– sometimes believe that NAAFA should spend all of our time and energy making sure fat people are healthy, either by proving that we’re healthy as we are or by constantly reminding fat people that “there are 230 medical conditions related to ob*sity” (more on that in just a minute). We have fat members, so we should either be talking about the dangers of fat or affirming that fat is not dangerous. That’s it. Health–it’s all fat people should care about, right?
But we don’t approach our work that way. Fat people need spaces where we can escape constant weight loss and health talk. As our media study last year showed, the ratio of coverage of fat as related only to healthcare and weight loss is outrageously out of proportion with coverage of anything related to justice or wellness for fat people in any other ways. NAAFA has always worked on concerns other than health, and we always will. That will range from everything from fashion, to employment equity, to transportation accessibility, to the arts. We can’t cover everything fat people need, but we don’t limit our work to only focusing on healthcare.
Still, we have always included healthcare advocacy in our work, both for individuals and for fat people collectively. In 2008 NAAFA created a Healthcare Bill of Rights to address the specific needs of fat people when it comes to interactions with the healthcare system. Patient bill of rights documents have existed since the 1970’s. The American Hospital Association (AHA) developed the first patient bill of rights (now called the Patient Care Partnership) in 1973. Since then, people and groups of all kinds have created community-specific or condition-specific patient bill of rights documents to educate people about specific needs. None of them are legally binding in any way, but they help create standards for treatment and they help healthcare clients self-advocate. They can also be used as tools to help shape government policy, as one of the latest sets out to do.
At the end of January, the National Council on Aging (NCOA) and the National Consumers League (NCL) released the Ob*sity Bill of Rights as part of their Right2ObesityCare campaign. At the time of publication, thirty-five other organizations had signed on to what they are calling a grassroots campaign. Supporting groups include the Academy of Nutrition and Dietetics, the American Nurses Association, numerous ob*sity organizations, Noom, and Weight Watchers. This bill of rights includes rights that NAAFA and other advocates for fat people have demanded for years, including access to size-accessible equipment, the right to be treated with respect by care providers, and the right to be fully informed about the care that is being provided to us. But this bill of rights also advocates for insurance coverage for “weight management” treatments and specifically focuses elders’ access to ob*sity care.
On the surface, there looks like a lot that could be celebrated here, even by people who are turned off by the medical terminology about body size. Don’t we all want fat people to get treated better within medical systems? Don’t we all want our community elders to get the health and wellness treatments they need?
Of course we want better care, accessible equipment, and insurance coverage for treatments we want and need. Even with our focus on weight-neutral care, we at NAAFA believe in body autonomy/sovereignty so we don’t advocate for preventing coverage of any counseling, procedures, or drugs. We do, however, want fat people to be making truly informed choices, choices that include access to all information about the pros and cons of pursuing intentional weight loss, not just the research that favors prescribing drugs and surgery as the “solution” to the alleged problem of being fat. The Ob*sity Bill of Rights says patients deserve accuate information from experts. But do the groups involved even commit to that themselves? Numerous ob*sity-related organizations, including the Obesity Action Coalition and the Obesity Society, both supporters of this campaign, assert that “Ob*sity increases the risk for over 230 medical conditions.” None of them actually link to a list of what those conditions are, and not one doctor or journalist I’ve asked has been able to point me to anyplace where this list exists publicly. (If you’ve seen it, do tell!) Notice, always, that we have to use terms like “associated with” and “correlate with” because the fat that is blamed for 230 medical conditions is not the cause of them, which is why all of them also occur in people who are not fat. If we want patients to be more informed, why is it so hard to get accurate information about what ob*sity actually correlates with?
We definitely want older fat people and all elders to be taken care of. But some of the very entities now advocating for ob*sity care for fat elders had no consideration whatsoever for fat elders until it became evident that they are a population that can motivate governmental policy change– namely, changes to Medicaid and Medicare that will net billions in profits the pharmaceutical industry if the law requires that these systems pay for drugs, surgeries, and other treatments related to weight loss. If private insurance companies also fall in line, the profits are even more astronomical.
Enter the Treat and Reduce Obesity Act (TROA), which is the ultimate goal of Right2ObesityCare’s efforts. This legislation, at state and federal levels, seeks to require that all insurance cover weight loss prescriptions and procedures. It claims to reduce weight stigma. It could also net billions for the medical weight loss industry. The Ob*sity Bill of Rights is meant to support such legislative change. Is it any wonder that those who stand to benefit so greatly are willing to dump millions of dollars into the budgets of the non-profits who are leading and supporting these efforts? Is it only coincidence that so many of the organizations pushing the new Ob*sity Bill of Rights and the TROA receive major donations from pharma and diet companies? Check the annual reports of the National Council on Aging (NCOA) and the National Consumers League (NCL). Both list Novo Nordisk, the makers of Ozempic, as major donors to their organizations. Maybe they just happen to agree on strategy. It’s certainly possible. But what would happen to their funding if they also advocated for weight-neutral care?
At NAAFA and in any advocacy based in fat liberation, we want better systems for all fat people, including better healthcare systems that address all of fat people's medical concerns. Any advocacy that is rooted only in increasing access to “ob*sity care” without promoting weight-neutral approaches to fat people’s health is misguided at best and incredibly harmful at worst. Whenever fat activists question the concept of ob*sity as a disease, we are accused of being science-rejectors who are just in denial about the dangers of fat because we want to stay fat. But that’s not the case at all. We don’t want less science. We want more science, unbiased science, science that considers the impact of anti-fatness on the health outcomes of fat people. (Some ob*sity advocates are now acknowledging that social determinants of health, including weight stigma, are part of what lead to negative health outcomes for fat people, but they tend to mention it briefly then retain a focus on weight loss as the solution to all of fat people’s medical and other problems).
I have no doubt that many of the folks supporting the Ob*sity Bill of Rights genuinely care about health and genuinely believe that treating ob*sity as a disease improves health outcomes for people. Many folks who are aligned with Right2ObesityCare’s approach really think that treating fat as a disease reduces stigma. But how’s that been working out for us? How’s that been working out for you? Since organizations like the National Institutes of Health, the World Health Organization, and the American Medical Association began categorizing ob*sity as a disease, has weight stigma decreased as they said it should and would? Has healthcare access increased? Are more fat people getting the care they need? By their own measures, the answer is no. They openly admit that weight bias keeps fat people from pursuing preventative care and help when they need it. So why are we doubling down on an approach that hasn’t been working?
The Ob*sity Bill of Rights presents itself as a grassroots effort to ensure equity, including racial equity through providing more treatment access to Black and Brown communities that include more fat people. Health groups targeting people of color are well-represented on the list of those supporting these efforts. Certainly, some of those groups are closer to grassroots than the gigantic and pharma-funded others on the list. Certainly, some of them are legitimately trying to protect valued members of their communities, not line their own pockets and help the drug companies do the same. It’s well-meaning work. But we believe it’s misguided, and even when these organizations are not directly funded by those who stand to profit from weight interventions, those profiteers have so much influence on the medical industry, it’s almost impossible to escape their influence. And their influence always points toward whatever “solutions” will net them the most.
Even when we are not explicitly talking about fat people’s health, all of the work we do at NAAFA to advocate for fat people’s overall well-being is advocating for fat people’s health. And we’ll continue to advocate for healthcare rights, too, because healthcare rights are a huge part of fat rights. We don’t get millions from pharma and diet companies to do this work. NAAFA has only recently begun to get some corporate funding and we are exploring further corporate funding possibilities because we want to support our work via many sources. But we don’t and won’t accept funding from businesses who make money off of weight loss. In fact, we get most of our funding from folks like you. As we continue to build intersectional relationships with community organizations across the country, we hope to get more actual grassroots activists and advocates to join us in questioning any approaches to community health that focus primarily or exclusively on ob*sity or weight loss. Your donations help us continue this essential work to make a better world for fat people everywhere.
(Author’s note: Let’s talk about the o-words. It is increasingly common to see fat activists and other advocates for higher-weight/larger-bodied people replace letters in the terms “overweight” or “obesity” with asterisks to indicate that these words are considered slurs by many people. Asterisks are also used as a form of protest of the way in which this terminology medicalizes all fat bodies. While there should be no stigma in having a disease or medical condition, the designation of all fat people as inherently unhealthy based solely on body size has increased stigma for fat people. Because the medical establishment has globally designated “obesity” a disease and “overweight” as a precursor to that disease, it can be difficult to avoid the terms when discussing fat people’s health and care. People First Language, such as “person living with ob*sity” is often used by medical professionals and is sometimes used by patients/clients themselves as their preferred terminology. It should be noted that dissent to the disease designation is much more common amongst medical professionals than is often portrayed. Although we acknowledge the terminology used by the medical establishment, we remind our followers and our allies that the medical system has a long history of using “official” terminology that is offensive and harmful to the target populations. At times, you will encounter the o-words in our current and historical publications and in the work of others to whom we refer you. At NAAFA today, we use a variety of methods to protect our community from harmful medical terminology, including use of content warnings, use of asterisks, use of quotation marks/“air quotes”, and/or use of alternative terms.)