Feature image by digicomphoto via Getty Images
Author’s Note: The word “obesity” is used in the source materials for this article and also shows up here.
There was a moment in my early teens where my mom was seriously considering putting me through bariatric surgery. My mom had been sorely misled to believe there is a correlation between being thin and being healthy, and it led to a lot of panic about my fat body. At that point, we had been to doctor’s appointment after doctor’s appointment to try to figure out the reason why I was either gaining or not losing weight despite many changes we were making to, mostly, my diet (since I was already a fairly active kid). A trip to the endocrinologist for a diabetes and thyroid screening that proved fruitless as possible reasons for the changes — or lack thereof. In 2002, bariatric surgery was much less common than it is now, though it was gaining some popularity as a realistic suggestion for weight loss and “‘obesity’ management.”
That summer, we went to a presentation at the Cleveland Clinic center near where we live. They went through the types of procedures available, the costs with and without insurance and, at the very end, the side effects of the surgeries. I was mostly bored and a little bit angry we had to be there. In my mind, this was never going to be something we could afford, so it didn’t seem imminently threatening or particularly traumatizing at the time. But I noticed something quickly shift in my mom’s demeanor when they started talking about the possible side effects: gallstones, hernias, malnutrition, food intolerance, low blood sugar, asthma, ulcers, bowel obstruction, and something terribly named “dumping syndrome” among many others. When the presentation ended, we walked back to the car quietly, she put on her seatbelt, grabbed the wheel with both of her hands and took a deep breath. “Yeah, we’re not doing that, Stef,” she said as she put the car into gear and we drove away. We didn’t talk about it much after that, but it felt like she was fearful of making a decision about my young body that could change the way I live my life entirely.
This seemingly small blip on the timeline of anti-fatness I’ve experienced over the course of my life isn’t something I think about often, but it did rush to the forefront of my mind a couple weeks ago when news broke that the American Academy of Pediatrics (AAP) has changed some of its guidelines for the treatment of children and young adults experiencing “obesity.” The new guidelines, which follow and are based on the bogus and increasingly obsolescent Body Mass Index (BMI) measurement, do suggest some actually useful things we should be doing in our society in general — like increasing the availability of highly nutritious, satiating foods for kids and families who need it and encouraging kids to spend more time doing activities and socializing — but they also suggest more aggressive treatments like weight loss pharmacotherapy and bariatric surgery. They suggest putting kids as young as 12 on weight loss drugs and allowing kids as young as 13 access to bariatric surgery. In fact, the doctors who helped write the guidelines suggest starting these treatments as early as possible because “waiting doesn’t work.”
If you’re feeling pretty weird about all of this, that’s a good thing. As we know, the weight loss industry — not necessarily the act of weight loss in and of itself — is extremely fatphobic and anti-fat. A brief look at weight loss and wellness culture will show you there’s an answer for every weight loss related need you might have. We have surgery and pharmaceuticals for people who have otherwise tried everything else. We have fad diets that fit just about any lifestyle anyone could possibly have. We have therapists and counselors and dieticians to help people manage their mental and emotional responses to stress and food. We have companies that make compression clothing specifically for people who have experienced dramatic weight loss that altered the shapes of their bodies. We have talk shows and podcasts and juice cleanses and tummy teas.
I want to be clear in saying that what people do with their bodies is up to them. I’ve had to make several changes in my own life recently in order to prevent some impending complications to my health. But I also think it’s important to realize that just like any other industry, the purpose of this one is to maximize profits and ensure our dependency on it. This move by the AAP is a good example of how far up the ass of Big Pharma the medical industrial complex is and how capitalists will stop at nothing to keep the system alive. And it’s a lot more than that, too. Some of these surgical “interventions” are irreversible, have long-term side effects, and have long-lasting impact on the body that could potentially impair a young person’s development. What’s even more concerning about these treatments is that a lot of the commentary from doctors who created these guidelines seems to imply that it is the parents’ responsibility — and their choice alone — to get their kids started on these intense treatments.
Anti-fatness and fat stigma are ingrained in every single aspect of our society. Anti-fat bias makes is harder for fat people to find employment and get promotions; it prevents them from earning the same salaries as their thinner counterparts; it makes it less likely for fat people to receive the proper care from doctors and other medical professionals; and of course, it often leads to social exclusion and bullying by peers, adults, and family members. Historically, made-up social hierarchies and stigmas regarding bodies and body features are rooted in racism and designed to impose oppressive forms of social control. Anti-fatness is based on the same principles of social control. The purpose of the perpetuation of anti-fat oppression is to create a society that fears and demonizes fat people. Fatness is deemed “immoral” in our society, which means that while this is about money, it’s also about policing morality and governing the ethics we adopt to live our lives. The most obvious and glaring issue with that is that when you make someone’s existence immoral, the society around them conforms to those ideals as well, which directly contributes to the negative health (and just fucking life) outcomes of fat people.
When you juxtapose the AAP’s new guidelines with the fight against trans kids’ rights to make decisions about their bodies, you can especially see what I mean by this. In the same way that fatness is deemed a moral failure on the part of fat people, being trans is also seen as a moral failing on the part of trans people. Where trans kids and their families are being made to feel as if they don’t have the medical (or emotional or social) authority to pursue treatment that would help improve their lives, fat kids and their families are being told that they must pursue treatment for “obesity” as soon as possible in order to “overcome it.” This current moment is a frustrating and genuinely terrifying study in the use of biopolitics as a weapon to control the trajectory of the many distinct and overlapping social classes. Giving parents the option of making their children take weight loss drugs or get bariatric surgery isn’t about making kids “healthier.” Just like taking away the possibility of gender-affirming care isn’t about making kids “healthier.” It’s about taking away people’s sense of bodily autonomy so they’re easier to control. In these cases, they’re starting at an extremely young age.
And you know what the worst part about it is? Y’all fall for it every single time. People will keep acting as if anti-fatness isn’t an actual form of oppression. People will keep acting like standing up for fat people isn’t a necessary and powerful and empowering thing for them to do. People will undoubtedly look at this as a good thing, as a thing that could potentially improve the health outcomes and longevity of a lot of people’s lives. While it might be true for some people that seeking these treatments are just for that, the suggestion — really, the insistence — to use these treatments on young people by the biggest pediatric association in the country is connected to a much larger history and system of institutionalized violence that puts the lives of fat people in danger every single day.
