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Fat as a public health crisis or a cultural obsession?

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We have generally accepted, as a society, that fatness is something negative to be avoided at almost all costs; however an intriguing transcript of a tweet chat by the Academy for Eating Disorders released Monday, Dec. 16 sheds new light on the issue. The tweet chat was led by Dr. Abigail Saguy, professor of Sociology and Gender Studies at UCLA and author of a recent book entitled "What's Wrong with Fat", which explores the conundrum that is weight.

This tweet chat consisted of questions posed to Dr. Saguy that she answered, along with considerable input from other professionals engaged in the chat. Although many topics were covered, some of the most salient for this debate revolved around issues of the medicalization of 'obesity,' treating obesity as a public health crisis, and the relationship between weight and health.

In terms of medicalization, in the mid-20th century, doctors coined the term 'obesity' in order to reframe it as a medical problem and to put it within the sphere of the medical community to address. This also consequently suggested that people who were obese were intrinsically unhealthy. Medicalizing obesity also has put it within the government's role to shape interventions to address it. Although there are other ways to see obesity in terms of diversity, and that there are varying forms of body shapes and beauty, our society has chosen to focus on obesity as pathological.

Since obesity has come into the purview of public health interventions, it has become one of the hottest topics of interest and also the one warranting the most government funding. Although it is important to address health consequences of obesity, it should not be understood that obese individuals are always unhealthy and that instead, there can be health at every size. Additionally, by framing it as a public health crisis, we inadvertently increase the risk of weight stigma and bullying based on size or weight in school, work, and the community.

In terms of the intersection between health and weight, although there are associations between weight and health consequences, Dr. Saguy reminds us that association does not necessarily equal causation. However, as a society, we accept without question that overweight or obese individuals cannot be healthy, although many still present as healthy and have normal cardiometabolic profiles. Additionally, almost a quarter of people in the 'normal weight' range have abnormal cardiometabolic profiles therefore showing that being thin isn't necessarily associated with healthiness. The primary point is that the association between health and weight is more complicated than we take for granted.

Clearly our societal constructions of obesity have simplified and stigmatized a very complex issue and the negative effects of this cultural construction will influence the lives of many before it is changed. This tweet chat was very enlightening and is just one step forward in a more compassionate understanding of obesity and obese individuals.

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