Editor’s Note: Michael Loewy, Ph.D., is associate professor and chair of the University of North Dakota Department of Counseling, with broad expertise in counseling theory and practice. His research interests include size acceptance, body image, race, gender, sexual orientation, and multicultural education and training.

Q. “Fat” is a bad word in America. Both medicine and the media tell us daily that there ’s an “obesity epidemic,” that we must shed pounds, that we’ve supersized our kids, that being “big” or “bigger” is both a social and medical liability.

Avoirdupois is a major national obsession that now cuts across age, ethnic, and socioeconomic lines. This “let’s-lose-weight” craze fuels a huge diet industry that has us clambering on scales, running to the health club, guzzling diet sodas, and popping miracle weight-loss pills.

As a self-labeled “fat man” and long-term critic of the weight-focused, diet-centered health “crisis,” you support healthy living; but, like the author of Big Fat Lies and others, you also argue energetically against the weight obsession. In a nutshell, what’s your issue with all the national obesity talk?

A. First let’s get the terminology right.  I don’t like the term “obesity” because it broadly pathologizes bigger, rounder bodies as if they were the problem. It perpetuates medical and psychological myths about body size. The scientific fact is that there’s no evidence that weight, in and of itself, is the problem. The term “overweight” connotes that there’s some “ideal” weight.  Both of these terms presuppose a correct weight and stigmatize those who don’t meet it, rather than acknowledging and appreciating the broad diversity in body size and shape that makes up the human race. We can no more control everyone’s weight than we can their height, skin color, or other physiological characteristics.  We may be able to affect these things a little bit environmentally, but mostly it is determined by genetics. You can read more about this by looking up “Set Point Theory.”

Q. The scientific and medical communities seem largely to support the modern notion that “overweight” and “obese” are medical conditions that need to be treated. But there are cracks in that wall: at a June 2, 2005, press conference, Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, apologized for contradictory studies regarding the dangers of obesity. Gerberding acknowledged that the messages about “fat” were mixed largely because flawed data in several CDC studies had overstated the risks. What’s going on?

A. What’s going on is a lot of people making a lot of money from the fear of being fat and the desire to be thin. Most of the research linking obesity with increased health risk is funded by some part of the diet industry or some entity that stands to profit from the spin that fat is unhealthy. Just because being a higher weight is associated with a higher incidence of certain illnesses does not mean that it is the cause. Nor does it mean that losing weight will reverse this association.

This kind of reasoning leads to lazy research and lazy clinical practice. The CDC rescinded their alarm about the deaths due to obesity, but the  “War on Obesity” rages on and the winners are the war profiteers, not fat people.  We are the losers because we have doctors who tell us to lose weight instead of seeing us as individuals.

Q. Medicine says that healthy living means maintaining a “healthy” weight, with charts and graphs that signal to each of us what that ideal weight is. A lot of advice focuses on losing weight as the key. If, as you say, weight in and of itself is not necessarily the problem, what health strategies to you suggest in your practice?

A. Let’s look at the standard advice: exercise more, eat less. Doctors have the nerve to look at you right in the eye and say this as if the person hearing it never thought of this before. Telling people to restrict their eating in order to avoid future possible health problems is like telling people to abstain from sex in order to avoid STDs. Sure, it’s simple, but it simply doesn’t work. A solution to this type of problem that fails much of the time, or that most people cannot adhere to over the long haul, is not a solution.  We’re basically using the same, tired old strategies (with respect to weight loss and health), and they’re not working.

In any other case, would doctors accept or prescribe a remedy that clearly does not work 98 percent of the time? I mean, we’re still dispensing the lose-weight advice even though we clearly know it doesn’t work. What kind of strategy is that? How can physicians prescribe a treatment---weight loss---with a 98 percent failure rate? And then blame the patient for the failure of the treatment.  Is that good medicine?

Q. What are you suggesting?

A. We need to focus on the real health risks instead of always masking them with weight. If blood sugar is the issue, let’s discuss the full range of options available to reduce blood sugar; if its blood pressure, the same applies. 

We want to focus on changing behaviors in ways that work when eating and exercise are getting in the way of health. To get that done, we must first accept that some of us are, and will always be larger than others, that some of us will be smaller than others. There are somatypes: ectomorphs, mesomorphs, and endomorphs. A person’s size does not always indicate their eating and exercise patterns. But even if it does, if we want to change certain eating behaviors, it helps to focus on those behaviors rather than on the weight as an indicator.

And, more importantly, we need to change social attitudes. 

You walk on campus, for example, a complete stranger will stop and tell you, “you look great, you’ve lost so much weight, how did you do it?” The message is always the same: you’re thinner, you’re good. But when you gain the weight back, you become invisible socially. People think it’s socially acceptable to make complimentary comments when you lose weight, but to think negatively when you gain the weight back or you’re “fat” in their eyes. 

I can tell you that I’m a proud fat man because I thrive and survive exactly the way I am in a society that wishes I would go away or change. Like many people, I’ve lost hundreds of pounds in my life. But I’ve gained them all back and then some. Society tells me that being fat is very bad; people are disgusted by fat, their own and others’. “Fat” is shorthand for lazy, ugly, sloppy, and many other negative traits. These are stereotypes that sometimes become self-fulfilling prophesies for people living in a society where the majority of people are scornful, insulting, and mean, or worse yet, pitying, if you’re perceived as fat.

Society thinks that if you’re fat, you’re an abomination, that you’re a glutton, that you’re sinful.

Now you’ve got preschoolers asking, “Mommy, am I fat?”  Children start worrying about how they look when they’re three and four years old. In essence, you’ve got children asking themselves, “Do I meet the cultural criteria for good looks.” I mean, we’re talking low-fat diets for toddlers! To me, that’s the abomination.

Q. As a psychologist, you’re telling us that weight-focused medical advice is failure prone. What other problems do you see associated with that?

A. For one thing, widespread job discrimination. Even the military has weight standards, as if that all by itself were a criterion for performance. You’ve got to ask, can he or she climb that wall or drive that tank and get the job done? Their weight alone is not the deciding factor in that. Strength and the ability to perform a certain job are not, or should not be, a question of “fit or fat.” The test should be if one can do the job, not what the person looks like when they are doing it.

The best health practitioners are now advocating the “health at every size” philosophy. Look it up. Too many doctors, however, are still fascinated by the body mass index; before it was the Metropolitan Life Insurance height-and-weight chart. But we’re confusing correlation with causation: they’re not the same thing. Weight and certain health problems may be correlated, but weight does not necessarily “cause” anything.

Q. It seems we’re talking about image v. reality here, an idealized view of what “should” be v. the reality that a lot of people have to live with. What’s your take on the image factor?

A. We’re totally obsessed with the ideal body image: we idolize professional athletes as paragons of health and fitness. Now there’s a group of people who have serious health issues. Sure they look great when they’re in the spotlight, but once they’re out of the spotlight, you learn that many have ruined their bodies, and may be tremendously unhealthy. 

Unfortunately, the health problems associated with starving oneself may be worth it for professional gymnasts, dancers or models, who earn enough to pay for good health insurance, but what’s the payoff for the everyday mom or daughter who is doing the same thing? Will they have the resources to recover from the devastation that yo-yo dieting does to the body?

Another key problem with our young women is that they now smoke more than men, and a lot of that behavior is a part of weight control. You’ve got young women saying that they feel like they’re forced to smoke just to keep the weight off.

Moreover, what you see is a social attitude that’s developed that says “if you’re fat, you’re obviously acting unhealthy.” So you must be morally inferior and you deserve to be discriminated against.

In other words, society says that if you’re fat, you’ve chosen to be deviant; it’s a lifestyle choice, so there’s no protection from prejudice. It’s sizism. In discussing the issue of fat bodies, we see the whole nature-v.-nurture debate all over again, just like with the gay question.  It’s a diversion, a way to avoid facing one’s own prejudices and fears of being “that way.”

Q. OK, so what are you doing about it as a scholar and practitioner?

A. To the extent that psychology, as a profession, endorses theories that promote people changing in order to “fit in” to society, it is guilty of being the standard bearer for the status quo, an agent of social control .

We have examples in the past of psychology being used to keep people oppressed so that society could “function more smoothly” (e.g., U.S. slaves who escaped were said to be mentally ill). 

But today, our profession is more about social justice, about resisting oppression. We recognize that people who accept themselves for who they are, demand to be treated equally, and fight prejudice are mentally healthy. Mental health is not found in fitting in to a dominant culture that diminishes you as a human being; it is found in resisting those forces and fighting for your dignity. 

This (UND counseling) department’s academic focus is at the cutting edge of the social justice movement within psychology. And that’s how we aim to fight this.

Some of us health practitioners, especially in psychology, have begun to be activists against this sort of negative body imaging that the media and other profiteers impose upon us. We’ve got to change this obsession with weight because it’s harmful.