In February 2013. I was admitted to hospital with excruciating, unexplained stomach pains. After checking all the usual suspects (gallstones, appendix), doctors eventually put me under observation, where I had to practically beg for what should have been a simple exploratory operation. Eight hours later I came around from general anaesthetic, having had an emergency laparotomy (where surgeons slice you from navel to breastbone) after it was discovered I was bleeding internally from a spontaneously ruptured spleen.
Yet the worst part of the experience wasn’t the physical pain – it was the hours I’d spent in A&E trying to persuade the GPs that I wasn’t exaggerating a case of heartburn or self-inflicted stomach cramps. I was fat, back then, you see, and when you’re fat any health problem is assumed to be somehow connected to your weight.
I wasn’t hugely fat by any stretch of the imagination: When I’m looking after myself properly (varied diet, regular exercise) my body settles at about a size 16 (and at almost 6 foot tall I consider myself rather wonderfully proportioned), but a year of travelling a lot for work, eating endless room service and not making time to exercise had rendered me around two sizes larger.
The doctor took one look at my size 20 frame and 36H boobs and declared that I was a ‘big girl’. That was his actual diagnosis. It’s only the friend I had with me to emphasise that I’m not prone to hypochondria which stopped them sending me home with a bottle of Gaviscon, where I would probably have died.
So that’s how being fat nearly killed me. Although perhaps it’s more accurate to say fat discrimination nearly killed me: And I’m not alone. In Sofie Hagen’s book ‘Happy Fat’ she cites a horrific survey carried out over a decade and a half which found that the fatter a patient is, the more likely a surgeon is to leave surgical instruments or sponges behind inside them following procedures. Hagen says “I had heard all the horror stories about fat people going to the doctor with a broken finger only to be sent home with a Slimming world introduction pamphlet”.
A 2012 study by the North American Association for the Study of Obesity found two out of three doctors believe overweight patients ‘lack self-control’, with 39% claiming obese people were ‘just lazy’. The science, however, simply does not support these attitudes. It has long been established that there are over 100 unique contributory factors - including genetic, hormonal, psychological and environmental - which determine an individual’s weight.
Furthermore, the evidence shows it is a person’s lifestyle, rather than the simple fact of their weight, which has the biggest impact on their over all health. Not all thin people lead a healthy lifestyle just as not all fat people are sedentary and eat mountains of crap. The journal Progress in Cardiovascular diseases stated in 2014 that fit fat people have the same mortality rate as fit thin people so, asMegan Jayne-Crabbe points out in her book ‘Body Positive Power’, saying being fat causes disease is like saying yellow teeth cause disease – there’s an element of the story missing.
As my Fact or Bull podcast co-host Dr Keon West says ‘mistaking correlation for causation is, like, really basic undergrad stuff’. So why do we continue to believe we can make sweeping assumptions about a person’s health based on looking at them?
The answer, I believe, is twofold. First of all, ‘being overweight is unhealthy’ is a simple narrative and therefore easy to digest (excuse the pun). Public health campaigns have form on this: It’s well documented, for example, that ‘five fruit and veg per day’ is just an arbitrary number, plucked out of the air, because 5 is easy to remember. Organisations such as Cancer Research UK, which recently launched their (widely criticised) ‘OBESITY IS A CAUSE OF CANCER TOO’ posters have probably convinced themselves that it might shock viewers into adopt healthy lifestyle habits in a way that a poster reading ‘EVERYTHING IS ABOUT BALANCE AND A CONSIDERATION OF MENTAL AS WELL AS PHYSICAL HEALTH SO WE HOPE YOU LOVE YOUR BODY ENOUGH TO NOURISH AND MOVE IT BUT IF YOU DON’T WE DON’T JUDGE YOU’ wouldn’t. (Yes, that’s probably it: I’m sure the fact that Slimming World is one of Cancer Research’s major funding partners had nothing at all to do with it).
The second is more sinister. Fat discrimination is one of the last socially acceptable forms of prejudice. Hate also sells. Humans love having someone to blame and hate, but that attitude is only sustainable if we believe the thing we’re hating them for is something they have complete control over. And that’s why medical studies which began their life as an examination of diet and exercise habits end with ‘BEING FAT IS KILLING YOU’ headlines lapped up by the public, despite all the contrary evidence in the form of life expectancy being longer than ever. Micro aggressions directed at fat people, both online and IRL can therefore be disguised as ‘concern for health’.
Of course, it doesn’t help that health is now an ‘industry’, with influencers without a nutritional qualification between them wading in to claim that cutting out a certain food group or consuming only kale smoothies before midday magically cured them of a broken leg. In reality, health advice is deeply unsexy in its simplicity: Eat a wide range of food groups, enjoy everything in moderation, take joy in moving your body regularly and however it looks is exactly as it was meant to.