Against health moralism

Concept of discrimination with an obese man pointed the finger for his overweight.

Here’s a recent comment from The Skeptical OB Facebook page:

I love how this page tries so desperately to falsely reassure obese people that it’s ok to be obese and there will be no long term complications to your health. It’s mental snake oil and people are eating this page up.

It’s similar to many comments over the last few day. The morally conceited apparently can’t tell the difference between health and moralizing about health.

The comments were precipitated by a series of posts and memes that called attention to the harms of health moralism.

Their devotion to the “health” of others allows the morally conceited to feel morally superior.

I noted that thin people feel superior to those who are overweight; that appeals to health involve moral assumptions, as well as power and privilege; and that we are hypocrites: demeaning those who risk their health by being overweight while venerating those who risk their health (and brain function) by playing pro football.

I didn’t think the argument was particularly sophisticated but clearly I was wrong. Many people confused my opposition to health moralism with opposition to health. Nothing could be further from the truth.

What’s the difference between health and health moralism? Health is a state of being; health moralism is a method of controlling others. I’m entirely in favor of people being healthy but I strongly oppose efforts to control personal behavior under the guise of promoting health.

Why? Because health moralism is astoundingly arrogant and often harmful TO health.

Consider this excoriation of preventive care by David Sackett, MD a pioneer of evidence based medicine. It’s really an excoriation of health moralism.

First, it is aggressively assertive, pursuing symptomless individuals and telling them what they must do to remain healthy. Occasionally invoking the force of law …, it prescribes and proscribes for both individual patients and the general citizenry of every age and stage.

Second, preventive medicine is presumptuous, confident that the interventions it espouses will, on average, do more good than harm to those who accept and adhere to them.

Finally, preventive medicine is overbearing, attacking those who question the value of its recommendations.

The moral panic over the “obesity epidemic” is a classic example.

Of course morbid obesity is a serious health problem with potentially deadly consequences. However, simply being overweight is not only safe, but actually appears to be protective compared to “ideal” weight. That’s what the scientific evidence shows.

Despite that:

– Health moralism pursues healthy individuals and tells them they are ill or will soon be ill.

But the truth is that you can be overweight and healthy.

You’d never know that from the disgust toward the overweight.

– Health moralism assumes that any problem experienced by an overweight person is due to weight.

But you can be overweight and ill and your illness is not caused or even affected by overweight.

You’d never know that from the harms that overweight people experience when trying to get care for health problems. They are often told that their problems are due to weight when they are completely unrelated.

– And, as the comments on my Facebook page demonstrate, health moralism is incredibly defensive, attacking anyone who questions their effort to judge and control the behavior of others.

You can recognize that overweight is a risk factor for — NOT an inevitable prelude to — illness without condemning those who are overweight.

But you’d never know that from morally conceited fatphobes who feel entitled to rage against any effort to treat overweight people honestly and with respect.

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  • Wow Amy!

    I actually agree with this.

    I have lived most of the past 28 years in health conscious Boulder Colorado and every time I lumbered into Yoga class in my plus size leotard, somebody assumed I was a fatty just getting into exercise for the first time.

    Usually it was the skinny gal teaching the class who looked like her body would struggle to craft a full bottle of breast milk much less the hundreds of gallons of milk my body had lactated over the years.

    She would generally say something pointless to me and then begin class.

    We all have to live and learn.

    Cheers!
    Jenny Hatch
    http://www.JennyHatch.com

  • mabelcruet

    OT a bit, but more lactivist stupidity. Theres a story in the Daily Mail today, the readers comments are always a hot mess, but some are particularly utterly brainless. The story is a minor UK celeb, Kate Lawler, who had a baby 11 days early. A few days after birth, the baby developed an infected finger. She was admitted for intravenous antibiotics. 8 attempts to get vascular access to administer the antibiotics were made, which suggests that the paediatricians were significantly concerned about it. But oh no, some of the commentators knew better-its just an ingrown fingernail, mama should have snipped it off and put breast milk on it, she didn’t need antibiotics when there’s liquid gold boob juice available.

    (I’ll not link to it, not giving that rag any more income!)

    • demodocus

      Do neonates even get ingrown nails?

      The rest is shite, of course. Poor baby, do you know how the litlte one is doing?

  • Who?

    My parents have been married close to 60 years. They have eaten all the same food, done the same exercise, and lived in the same environment all that time. They are both slim and active people.

    Mum has just had a couple of hospital stays for a heart issue, first time in 32 years she’s been in hospital. She has 13 siblings, all who lived past 70 and more than half of whom are now over 80. She has all her organs and has never had major surgery. Dad has four siblings, all younger than him, two of whom have died, one fairly recently. His last surviving uncle died last week aged 87.

    Dad had five heart arteries bypassed at 80; he had both knees replaced in his early seventies, and not long after that had cataracts removed from both eyes.

    Mum won the lucky uterus competition, Dad won the ‘born at the right time and comfortable in a rich country’ competition. They exercise and eat right, which is nice, but their different trajectories maybe tell us something about what works. I’ll take the lucky uterus.

  • demodocus

    Sigh. I self-medicated 20 years ago with food. About 15 years ago I had all but stopped, but the damage was done. Switching to more fresh foods and whole grains (Because my husband’s salary allowed it better than my mother’s had) and walking everywhere (because I had no choice) and I lost a little weight that first summer. Then nothing. For years. Still walking, still eating mostly fresh foods. I’ve gained 20 pounds since, 10 each in the wake of my pregnancies, and I’ve maintained since.

    But sure, it’s clearly a moral failing. If only I ate less and exercised more!!! If only I go hungry every day and while also taking up jogging, because walking miles a week hasn’t made a damn bit of difference.

  • alongpursuit

    Thanks for putting your finger on the health vs. health moralism debate. I felt this so much with the “Baby Friendly” Hospital. All the aggressive EBF promotion for what, exactly? I certainly still feel shame about formula feeding. The Sackett quote is excellent.

  • fiftyfifty1

    When I practiced in a wealthy area there was a ridiculous level of health moralism. So much preening over not being on any prescription medicines. So much bragging about diets and workout regimens. My favorite boast was the guy who claimed “I’m teaching Father Time a lesson!” Nope. Nobody teaches Father Time a lesson.