The obligation to be healthy at every size.

It is sad that this even needs to be said, but given the fact that we essentially live in a health meritocracy, let me be the first to announce:

You are under no obligation to be healthy.

And, as an addendum: even if you were, eating “well” and exercising wouldn’t guarantee your success. There. I’ve said it. And as much as this might chap the ass of every health promoter out there, I feel that personal agency and a basic sense of privacy are sorely missing from most conversations of health promotion, and from conversations of Health at Every Size.

Health at Every Size exists in order to address the health concerns of people who, well, have health concerns. It is not, nor should be, a vaunted ideal that everyone must strive to live up to. It is an alternative. To what? To weight-loss dieting, to punishing “health regimes,” to doctors whose anti-fat bias drives them to diagnose you as fat and send you limping off on a sprained ankle with a prescription for steatorrhea.

An alternative, not an obligation.

It’s sad that we’ve come to the point where this needs to be pointed out. But it seems to be the reality that health habits, and health status, are no longer private matters. When people believe that you are receiving health care services off their backs and their premiums, they believe it becomes their business to police your personal habits. When health becomes not just an indicator of damn good luck, but of social status — because only responsible, smart people know how to avoid getting sick, and have the money for all those special foods/supplements/alternative therapies you’re supposed to buy in order to be a worthy citizen of the health meritocracy! — people forget about respect for their own and other people’s privacy.

This, despite the fact that the definition of health itself has not even been definitively pinned down, that it has evolved through numerous variations through the years, and will likely continue to evolve. Despite that nutrient requirements are different for each person. As are genetic profiles, family histories, and every single one of the social determinants of health.

The factors that determine health are different for everyone — which means it is up to you to decide what to do. No one can do it for you.

But we live in an era, a really strange era, where our life expectancy is better than ever before, and where we have (arguably) adequate access to health care. But, in some kind of terror, we strive continually for a zero-risk situation — and we strive for it not by addressing systemic disparities in access, but through laughably insignificant personal attempts, and individual finger-pointing.

But there are no zero-risk situations. Even people who do everything “right” sometimes get sick and die. In fact, everyone eventually gets sick and dies. Despite attempts to the contrary, our mortality rate as humans remains stubbornly at 100%.

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11 Comments

  1. Ann
    Posted June 7, 2009 at 9:11 am | Permalink

    I am deliriously happy to hear someone say this.

  2. Rosesred
    Posted June 7, 2009 at 10:56 am | Permalink

    I just love how you put things, so succinct. I’ve been thinking about this, how society seems to assume health is totally controlable, and is your own responsibility (both not true anyway),and yet feels justified to police peoples weight and behavior. Appearantly it’s only up to you when you follow society’s rules to the letter.

    Very happy to have found your blog, enjoying your posts so far.

  3. Posted June 7, 2009 at 7:04 pm | Permalink

    Thanks, you two. I hope you stick around and help me suss some of this stuff out.

  4. h-jg
    Posted June 8, 2009 at 3:59 am | Permalink

    Enjoyed this post. Ultimately, I think the cost of valuing “zero-risk” life course, and valuing attempts to expand life expectancy off into infinity, are that anyone who decides they really don’t want to live forever are profoundly othered. It is really quite amazing how unintelligible people find me when I say I don’t necessarily want to live out my entire expected life course ( life expectancy in Australia is 83 for women I think). “Zero-risk” situations are also caught up with eugenics, and I think that’s why there is so much focus on biopedogizing family units and policing what women eat during pregnancy, because the myth is that “fat” parents will have “fat” kids, and “fat” kids will have shorter life courses- why?- *because* they are “fat” (no explanation needed). Therefore we have some doctors saying women with a BMI over a certain amount *won’t* be able to get pregnant, in order to eliminate the *possibility* of “fat” children. A bit like the way some women are told having Down Syndrome babies is bad because they *will* have shorter life courses, and we all know this is a *bad* thing.

  5. Posted June 8, 2009 at 6:58 am | Permalink

    A beautifully eloquent blog post. My body is mine, and anyone who wants to tell me what to do with it can sod off!

  6. Posted August 11, 2009 at 8:33 pm | Permalink

    Amazing! I’m so happy and relieved to hear something like that. Guess I’ve waited my whole life to hear something like that! Thank you so very much for pointing that out! Your writing has been very helpful, because you’re able to express what I feel and can’t say sometimes.

  7. Posted September 1, 2009 at 8:26 pm | Permalink

    Wild applause.

    I’m getting really sickened by the side of the health care debate that talks about “undeserving” people – When people’s arguments sum up as “I have a certain level of care (and privilege) that I’m worried will go away if I have to pay for all the undeserving people.”

    Right now my knees are swollen and hurting – I fell a few months ago and injured them and the swelling & bruises still haven’t gone away, but I feel shame about it – shame about an injury that wasn’t my fault – because I am a fat person and sometimes feel an obligation to show how healthy I am.

    Love this blog, thank you so much.

    • Posted September 1, 2009 at 8:49 pm | Permalink

      I know that feeling of obligation very, very well. It’s amazing what unhealthy things we’ll do to ourselves, supposedly in the name of “health.” But it’s obviously not health — so what is it, really? I’m still puzzling that one through. But I think it has something to do with social inclusion — we are primates, after all. Exclusion = death, biologically.

      Thank you very much for your support. It means an incredible lot to me right now.

      Also: the name of your blog rules.

  8. Posted May 18, 2010 at 12:16 am | Permalink

    Thank you, very very well put. So glad to have stumbled across this page! I am currently going to great lengths to learn to ignore such invasions of my privacy and live truly.

  9. GiniLiz
    Posted August 11, 2010 at 6:45 pm | Permalink

    As a HAES-oriented fat health educator, I am thrilled to have been introduced to this blog recently. This post, in particular, made me smile. I get a bit ticked when other fatties argue against HAES claiming it, at its core, is healthism. No, HAES lingo may be used for healthist purposes, but that is not its core. I believe it was a member of the showmethedata listserv who once said “HAES is a prescription for doctors, not patients.” I like that! It’s a paradigm, not a program. I told an academic advisor once that HAES is what we’d probably all be doing – without any official description of our actions – if we hadn’t learned and internalized all this “obesity” rhetoric. Just like we usually don’t have to learn “intuitive peeing” or have a “health at every bladdar size” paradigm, we’d simply be eating according to our bodies’ needs, moving according to our bodies’ needs, and being the sizes we are. HAES is a (hopefully only temporararily needed) articulation of an alternative approach to health. In and of itself, it does not say what people – of any size – “should” do or whether people are better people if they follow HAES principles in their own life. It is simply an articulated alternative to a weight-based health paradigm. That is all.

    • sannanina
      Posted August 16, 2010 at 10:33 am | Permalink

      Just wanted to say that there are actually situations in which people have to relearn how to pee… In fact, I also think there are situations in which eating according to internal signals does not really work either, but they are rare, and they are usually the sign of an underlying illness.

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