Esa's Notebook

Fat acceptance s a movement that emerged in the US in the 1960s with the goal of changing negative attitudes towards obesity,. The National Association to Aid Fat Americans was founded (National Association to Advance Fat Acceptance (NAAFA)). The Fat Pride movement was born from this ground. In early 70s, the feminist group The Fat Underground was founded. They stated that U.S. culture is afraid of obesity because it is afraid of powerful women. 

For me as a doctor – and I believe this is true also for the majority of doctors – it’s difficult to fully understand the reasons and objectives of the Fat acceptance phenomenon. During decades abundant scientific evidence has accumulated showing the disadvantages of obesity. Any kind of obesity is not a normal physiological condition for a human but is basically always harmful. There is no such thing as “healthy overweight”. There are at least two reasons for that.

One is of course that fat tissue has so called proinflammatory effect on the body leading to low grade inflammation. This increases the risk of cardiovascular, liver and kidney disease, chronic obstructive pulmonary disease and rheumatic diseases. Obese bodies have been associated with heightened health risks, the most prominent among them rising rates of chronic illnesses such as diabetes, cardiovascular disease, hypertension, mental illness and some cancers. Early in the pandemic, research identified a link between larger-bodied patients and higher mortality rates from COVID-19 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443289/).

Then there is also an evident fact that over time, the heavy body weight strains the load-bearing joints – ankles, knees, hips – and exposes them to cartilage wear. Joint wear and tear can be an extremely painful condition that makes movement difficult or impossible. The situation is further complicated by the fact that extreme obesity can be an obstacle to repair operations due to the increased risk of complications. Then we have reached a kind of stalemate.

Fat acceptance activists may state that I do not have the right to judge their way of life and being obese. However, as a health care professional, I am kind of obliged to note  – not judge – a person if  I notice something that is disadvantageous for their health. Similarly, one could argue that I would not have the right to point out a person for smoking.  That I will certainly do,  if I am going to be a self-respecting, professional doctor. There are, of course, differences in how things are emphasized to patients. As far as obesity is concerned, I have to say that its health hazards have become clear to everyone for decades, so no one can hide behind the fact that they did not know.