Jeanette DePatie is a bubbly aerobics instructor with boundless energy and enthusiasm for helping people achieve their fitness goals.
She is also, in her own words, fat.
But being fat, DePatie says, is simply another character trait, just like being short, brunette, and having hazel eyes — none of which impacts her health status.
Dubbing herself “The Fat Chick,” DePatie proudly challenges stereotypes of what larger bodies can accomplish with the mantra “every body can exercise.”
And in her efforts to highlight behaviors over body type as a measure of good health, she joined a movement called “body positive” that hopes to shake up conventions about what it truly means to be healthy.
At its core, body acceptance is the recognition and celebration of body types. And in a culture that tends to value thinness as the feminine ideal, the movement has particularly resonated among larger-bodied women.
Body-positive activism has also channeled into a greater discussion of health that encompasses diverse body types. But as the movement progresses, body-positive activists are forced to contend with a culture that views good health and larger bodies as incompatible.
Promoting Health Through Body Acceptance
For people like Harriet Brown, body acceptance has been life changing.
The professor of magazine journalism at Syracuse University has written extensively about issues of weight and body image, including her personal struggles.
After years of yo-yo dieting, self-loathing, and frustration, a therapist’s suggestion that Brown could be at peace with her body was an intimidating, yet exciting, prospect.
“It had never occurred to me that you could be OK with your body, whether it was thin, fat, or in-between,” she said.
Brown has written a book, "Body of Truth: How Science, History and Culture Drive Our Obsession with Weight -- and What We Can Do About It."
Throughout Brown’s journey toward accepting her body, her research and reporting have often focused on a theory called Health at Every Size (HAES) that has become central to the discussion of body positivity.
The theory boils down to a focus on health regimens that work for individual bodies, rather than striving to reach a certain body size.
And as is the case with many tenets of body acceptance, HAES is subject to plenty of criticism.
“There’s a strong misperception that anyone who talks about body positivity or fat acceptance or Health at [Every] Size [is] really saying is ‘Oh, I give everyone permission to sit on the couch and eat bonbons all the time,” Brown said.
“If that’s your personal choice that’s your personal choice,” but “this is about saying there’s more to health than that one single number,” she said.
The idea that body positivity serves as a license to take part in poor health behaviors is one that proponents reject as an incorrect interpretation of the movement’s mission.
“Body positivity is not saying it’s an excuse to be fat or unhealthy, but it’s a way of saying we don’t need to put each other down and we don’t need to put ourselves down,” said Dr. Christopher Leeth, licensed professional counselor, assistant director of counseling at the University of the Incarnate Word and lecturer at University of Texas at San Antonio.
HAES flips the discourse on how the outcomes of health-centered behaviors are viewed, placing value on behaviors that promote holistic health to support people physically and emotionally.
“The big thing is tuning into yourself,” Brown said. “How do you feel? Paying attention to that rather than the messages that are coming at us from so many different directions.”
In broadening the scope of what is deemed healthy, HAES also challenges people to consider the language typically associated with health.
“Every time that word [diet comes up], we always associate it with body shape, when the emphasis should be on a healthy diet that makes you feel good,” Leeth said.
One vocal proponent of the cause is Ragen Chastain, who has taken the principles of HAES to heart and educates others on the movement’s uplifting outlook.
While heavier in build, Chastain has always been athletic. She says her body size has never prevented her from engaging in a range of invigorating physical activity.
Rather, negative assumptions about her weight have been the greatest barrier to fulfillment.
“I feel like I've never suffered from obesity but I have suffered from the oppression around it,” Chastain said. “I spent so much time hating my body for not looking like a photoshopped model that I didn’t have any gratitude for what my body did for me.”
Now she puts her energy toward the healthful behaviors she loves most, particularly dancing. She has found both joy and exercise in competitive dancing.
She documents her experiences and musings on her popular blog, Dances With Fat. She’s also currently training for her first Ironman triathlon.
Increasing Visibility for the Movement
One of the ways in which the body-acceptance movement has empowered larger individuals is through the increased visibility of a diverse range of body types.
Recently, plus-size model Erica Schenk earned widespread acclaim when she graced the cover of Women’s Running. She told the magazine, “Women of all sizes deserve to be praised for good health and have a presence in the media.” She said the best part of her cover appearance was demonstrating just that.
The visibility of role models like Schenk has been invaluable to advancing the body-acceptance movement and has paved the way for others to focus on health-promoting behaviors rather than striving for a certain weight.
Newcomers to Jessamyn Stanley’s yoga class sometimes underestimate her abilities.
“People come to my class thinking it’s going to be easy, or because I'm larger bodied that for some reason it would be not that hard,” she said.
But by the end of class, Stanley says, her students have worked up a sweat and challenged themselves physically and mentally.
As a self-described fat person, Stanley doesn’t fit the stereotypical image of a lithe yogi. And it’s this contrast that has made Stanley a powerful force on social media.
“It’s like I'm infiltrating the traditional yoga community,” she said.
Images of Stanley balancing in complicated poses — which she performs without covering up her body — have gained the admiration of thousands as well as a great deal of media attention.
Stanley never intended to spark such a buzz when she began posting her yoga pictures on her Instagram, but the mere act of visibility turned out to be a radical one.
“For a lot of people it’s extremely revolutionary,” she said. “I’m not afraid of my body. I’m not afraid of how it looks and that’s inspiring to people.”
Criticisms of Health at Every Size
As HAES emphasizes, the thinnest body isn’t necessarily the healthiest.
A host of factors impact one’s overall health status, from genetics to environment. There’s also no one magic number on the scale that everyone should aim for, a point that body-positive advocates regularly underscore.
However, while health experts generally agree that it’s difficult to determine a person’s health status without a full physical evaluation, they also stress that extra weight can lead to medical complications down the road.
Many in the medical community argue that regardless of behavior, weight needs to be evaluated.
As the medical director of the Carolinas Weight Management center, Dr. John J. Tomcho, D.O., R.D., is familiar with a variety of body types that don’t fit a single definition of health. However, he does observe an overarching concern.
“I see a lot of people obviously with [a] BMI northward of 40, and they can come in and get blood work and be absolutely fine, but that pressure of the extra weight on the body eventually will take its toll,” Tomcho said.
He notes the widely documented risks associated with obesity, including diabetes and high cholesterol and blood pressure, but he says the composition of weight rather than weight itself is of the most significance when it comes to health.
“With a high percentage of muscle you’re actually going to be quite healthy,” Tomcho said. “It’s the fat tissue that causes the majority of the problems and trying to reduce that is key.”
Leslie Heinberg, Ph.D., director of Behavioral Services at the Bariatric and Metabolic Institute at Cleveland Clinic, also takes a nuanced approach to discussing weight.
With self-care so strongly rooted in body positivity, Heinberg believes that considering the impact of weight should be a component of body-acceptance rhetoric.
“Part of loving yourself is taking the best care of your body,” she said. “That should be part of that same goal, versus ‘I love myself just the way I am.’”
Patients, Providers at Odds
Healthcare providers and heavier patients are often at odds when it comes to determining what’s best for their health.
A common gripe among body-positive activists is shaming from healthcare professionals, regardless of whether the conversation is about an issue unrelated to weight.
“You’re fat and you go to the doctor, you could be holding a severed limb but they’ll be like ‘Oh but what are you doing about your weight?’” Chastain said.
On the flip side, Tomcho and Heinberg see it as their professional responsibility to educate their patients on the full spectrum of health risks associated with obesity.
“People are adults, they can make their own decisions and I want everyone to feel good about themselves, but I want them to do it from a fully educated point,” she said.
According to Heinberg, the amount evidence linking obesity to health problems is overwhelming.
“There has been a selection of studies that don’t show any impact, without showing the preponderance of studies that show being obese has some health effects,” she said.
For example, one popular theory that pervades HAES activism, the so-called “obesity paradox,” suggests that older age protects against the risk of obesity-associated death. However, a number of studies have debunked the theory, arguing that such protection is short-lived.
And while some studies have suggested that obesity can be healthy when lacking comorbidities such as type 2 diabetes, an extensive body of research contradicts the theory, finding that even healthy obesity is unsustainable long-term.
Even though some healthcare providers and larger patients may disagree about the best type of care on an individual basis, the unproductive shaming that many larger patients experience at the doctor’s office remains a legitimate concern, activists say.
“It’s absolutely critical that we factor in the health costs of stigma,” DePatie said. “If I go to the doctor and I’m shamed by my doctor, there’s an emotional cost to that and there’s a physical repercussion to that.”
Finding a kinder way to engage in conversation is one way to bridge the gap between larger patients and providers.
“Ignoring obesity I don’t think is good care, but we can certainly discuss it in a less shaming way,” Heinberg said.
Tomcho shares a similar view. “I don't think you can take away individuals trying to have a positive outlook on [themselves], there’s nothing wrong with that,” he said. “But you have to take it into the right context as well.”
Coming to an Understanding
For many body-positive activists, there’s no question that body size doesn’t necessarily reflect one’s health status.
While this line of thinking may be problematic to some, remembering why so many larger-bodied individuals feel the need to carve out their own space within the health community is important for deeper understanding.
“The idea of body acceptance and Health at Every Size is so powerful and so hopeful for people turning themselves inside out trying to lose 15 or 20 pounds, trying to reach this idealized [body image] when biologically that’s not who they are, that’s not who they're destined to be,” Heinberg said.
Strip away the noise, and the message is simple, as Heinberg explains.
“Body acceptance is really about accepting the body you likely have but still striving to have the healthiest body you could potentially have,” she said.