Correlation is Killing Us

I received an e-mail from reader Melissa who asked some good questions really respectfully, so I thought that I would answer them publicly.  To be clear, when I talk about trolls and such, I’m not talking about Melissa, it just happens that her questions frame a larger debate that I and lots of other fat people deal with:

If study after study shows us a correlation between obesity and the so-called diseases of civilization, aren’t you curious about the potential causal link there? Some of the study authors may be doing bad science, oh yes indeedy, and I’m not implying that the way the media goes about reporting on these things or pushing the “beauty ideal” is the way to go. And I’m certainly not arguing with you that you can’t be fit—all evidence suggests to me that you are. Do you believe that obesity’s correlation with disease is unrelated to the obesity itself and may be a result of other choices that some obese folks make (such as not remaining as fit as you)?

First, there is a reason that “Correlation does not imply causation” is such an important fact. It is the most basic tenet of research. The problem with correlational research is that it only proves that things happen at the same time, it does nothing to prove that one thing causes the other, and if you can’t prove the cause then you don’t know the cure.

  • The body size and the health issue could both be caused by a third factor
  • They could be unrelated and so losing weight would just mean that they would just have the same problem in a smaller body.
  • The health problem could be causing the body size and so weight loss would either do nothing or could even exacerbate the problem.
  • They could caused by two different things and then neither issue is treated properly.
  • They could both be side affects of a behavior, but the behavior change my help the health problem but not change the size of a person’s body – unfortunately that person may be labeled a “failure” because, even though they reversed their health problem, they “failed’ to reverse their weight.

These are just a few possible scenarios.  I’m not saying a causal link is impossible, I’m saying that it’s not proven and that nobody seems to be too worried about finding out because they are too busy yelling “IT’S YOUR FAULT FATTY EAT LESS AND EXERCISE MORE!!’  Look at the comments these two posts on health and you’ll see story after story of people who received poor medical care because their doctor thought that weight loss was a cure-all.  Hell yes I’m going speak out against this practice and point out every chance I get that there is NOT a proven causal link because lots of people, including medical doctors, think that there is and that lack of simple knowledge can kill people.

The media does an abhorrent job of researching stories about weight and health before they spread them far and wide and so a study wherein 3% of children lost weight on a diet gets the headline “Say Goodbye to Obesity”.  The CDC retracted their statement that 400,000 deaths per year were caused by “obesity related disease”. The retraction stated that only 110,000 deaths could be connected and admitted that “the link was probably weak” but I’ve seen three stories this week that said that according to the CDC 400,000 deaths a year are caused by obesity – which not only ignores the retraction, but also the fact that nobody ever claimed causality except the media.

I’ve never said that I know the answers to these things, I’ve just pointed out that there is evidence that runs counter to the mainstream, and that people are running around acting like they know the answers when they don’t.  And if the media’s numbers are to be believed, it’s putting the health of over a third of Americans (who are “obese”) at risk due to improper medical care.

There are thin people who have diseases correlated with “obesity” and “obese” people who don’t.  I think that we need to stop looking at weight and start looking at health.  We have the ability to evaluate health with everything from blood pressure cuffs to blood panels to VO2 Max scores, so there’s just no reason to look at someone and make guesses about their health based on their size. It’s just cheap, lazy medicine.  Also, when we continually repeat that weight is the “reason” for health issues, it gives thin people a false sense of security that they are healthy as long as their bodies remain small.

I believe that health is a combination of genetics, access, environment, stress, and behaviors. I also think that people’s prioritization of their health and the path, if any, that they choose to get there is nobody else’s business.   Telling people to lose weight to be healthy is telling them to do something that nobody can prove is possible for a reason that nobody can prove is valid and I have a problem with that.  I don’t think that health is a moral, societal, or personal obligation but I do think that if someone is interested in greater health, the best chance that they have is to practice healthy habits. (Actually, statistically the best chance is to be born to wealthy parents with good genes in a city where they have access to robust healthcare but I assume if they’re reading the blog then that opportunity has either come to fruition or passed them by.)

I do not see how blaming everything on a ratio of weight and height and telling people that the solution to their problems is to give their body less food than it needs to survive so that it eats itself thereby becoming smaller and changing their height/weight ratio (despite a marked lack of evidence that that is even possible over the long-term, or that it will solve their problem if it does) is a better idea than telling people that if they want to be healthy they should practice healthy habits and then actually evaluating their health to check their progress.

Lastly  I wanted to note that it might be helpful for ammunition against your detractors if you kept a food log for a couple of weeks and posted it. This, it seems to me, would be as great a testimonial for who you are and how you live as the lovely exercise photos. They may not all believe you’re telling the truth, but some might, and it’s possible that some will then question the old “calories in, calories out” canard. I think that’s a worthy goal. 🙂

No.  I don’t try to prove things to people any more.  I understand that you are well intentioned and where you’re coming from with this, but I’m not going to do it. I’ll post my food log and then I’ll have to deal with 1,000 comments and e-mails where people call me a liar, or tell me what I SHOULD be eating to lose weight, or offer to let me try their weight loss plan for free etc.  I don’t feel like dealing with it and I don’t owe anyone an explanation.

This blog is not meant to be an exercise in persuasive writing and it’s not my job to prove anything to anyone, least of all my detractors.  (To be honest, it wasn’t that long ago that 6 people, including my mom, formed the entire readership of this blog, so the fact that it’s popular enough to have detractors makes me kind of  happy.  Although, of course, not as happy as the fact that I have fans – I can’t even type that without smiling).  I try my best to provide my well-researched, thoughtful, and level-headed (most of the time!) point of view that is outside of what the diet industry spends billions of dollars a year promoting.  I doubt I have a single reader who agrees with everything I’ve ever said.  Some people like my blogs about self-esteem and body size but disagree with what I say about science and statistics.  Some people love my science and stats blogs but say that the self-esteem and body size ones are “fluff”.  Some people get upset that I write blogs responding to criticism.  All of that’s fine.

In blogging as in life, I think that the absolute worst thing that I could do is try to become what I think other people want me to be.  Not only does it not typically work, but it would leave me in a place of being inauthentic which is way worse than being disliked or called a liar.  So my detractors can detract away while my fans – like Melissa – can read this blog and others like it, ask questions, and have intelligent and interesting discourse. Yay us!

Like my blog? Here’s more of my stuff!






Published in: on July 20, 2011 at 8:02 am  Comments (79)  

79 CommentsLeave a comment

  1. This. This. This. And this. Really. Such a brilliant post.

    Also, “I don’t owe anyone an explanation.” Amen! Nobody owes anyone an explanation of their body shape / fat percentage / lifestyle / personal choices. This is my (fat) body, you have your body. I respect your right to have whatever shape body you have without it being an indicator of your moral strength or personal value, I ask that you show me the same respect. It’s really not that hard.

  2. The real telling thing that she says is:

    “and may be a result of other choices”

    Disease is not always the result of choice. It may be the result of inherited genes or random mutations or exposure to toxins in the water and air that you are obligated to breathe and drink if you want to live. People want to think that fat is a choice, and that all disease is a choice, because it makes them feel immortal as long as they are making “good choices”. Leaving aside that for many it’s impossible to, say, choose your genes or move away from that radon-contaminated house that’s the only asset you have, the medical establishment and Big Food do not even know what “good choices” are. For the last few decades we’ve been encouraged to eat seed oils instead of butter and now it turns out that those oils may cause a lot of inflammation and maybe the butter was better all along. Who made the bad choices there? The people who followed the nutritional scientists’ “conventional wisdom” and then oh wow oops we were wrong?

  3. I agree with most of what you’ve said here – especially the decision not to post a food log! If you have to do that, I want thin people to post their food logs to ‘prove’ how virtuous they are, and show that they never, ever eat sugar or chips because if they did, they couldn’t possibly be thin. I mean, it has to be all diet, right? It can’t possibly be their metabolism.

    However… I am slightly uneasy at the ‘correlation is not causation’ sentence. It is true, of course. The fact that people eat more ice creams in summer isn’t responsible for the bird migrations at the same time.

    But, but, but. It’s also not true. Very tight correlations can turn out to be very important, particularly in public health. Nobody ever proved in a laboratory that smoking was bad for you – it was the strong correlation between smoking and lung cancer that did the job.

    • I have a hard time believing that the lung cancer/smoking link is only a correlation. We know the ingredients in cigarettes and know that most are proven carcinogens.

      • For a very long time, a statistical relationship was all people had to go on. It clued them in to the fact that something terrible was happening, but they didn’t know what.

        The correlation was first noticed in 1948. Research done in the 1950s continued to show a strong correlation, which Big Tobacco insisted did not mean tobacco was causing the lung cancer. It wasn’t until 1996 that a direct cause was demonstrated between cigarette carcinogens and cancer.

        I’m not saying that all correlation IS causation. Except that, sometimes, it is.

        • Nope, correlation is NEVER causation. Sometimes there is a correlation is found and then causation is proven by other means but they are two separate things. There are far more things that are correlated with no causation than there are things that are correlated and then proven to have a causal relationship, hence the foundation of research being that “correlation never implies causation”. Plus, the comparison with smoking is not a good one. Smoking is a drug deliberately taken into the body and we can easily compare those who take the drug and those who don’t. We can also prove the affects of the drug on the body, and therefore the reaction to the body in the absence of the drug. Obesity is a height/weight ratio and people with the same diet and exercise habits have various height/weight ratios, metabolisms and levels of health and so it’s not so easily definable or comparable.


          • I love this response. As I really like this blog entry. You are so sharp, smart and can really get your point across.

            Thank you for what you do, you have helped me so much!

      • Ragen, you have a new fan. 🙂

        The elusive factor that is usually missing from all these “correlation” stories in INTENT. I am the hugest non-smoker around but I know full well that there have been documented cases of life-long smokers who did NOT die of anything related to smoking because they never “intended” to do so (either implicitly or explicitly). I am a big proponent of the Law of Attraction which in most ways can be summed up as “You get what you think about whether you want it or not.” You, Ragen, are a great example of this in action as you are vibrant and healthy because you CHOOSE to be! Blessings to you.

  4. This morning’s Globe and Mail (loosely speaking, the New York Times of Canada) contains an article entitled “New research indicates seven health risks that are contributing to Alzheimers’s”.

    Here they are:
    1. low education
    2. smoking
    3. physical inactivity
    4. depression
    5. high blood pressure
    6. diabetes

    and…drum roll please…

    7. obesity. “Women and men who are obese at middle age have an increased risk of dementia later in life. Worldwide about 3.5 per cent of the population is both obese and middle-aged. The study found that obesity is associated with about two per cent of Alzheimer’s cases.”

    Since we lay people (and in particular we fat people) obviously can’t understand the science behind such pronouncements, none is included in the article. Very helpful and very scientific. [sarcasm]

    • And I seem to recall reading somewhere that getting the flu shot five years in a row can do it too and oh, hmm, something interesting there because what group is usually pushed to get the flu shot? People with diabetes, especially those who are fat, I’m sure (remember when swine flu was pushed on fat people because being obese meant more complications?). SO, that in and of itself could be the reason. Gotta love how they’re trying to blame fat itself on Alzheimer’s. I thought genetics had something to do with it too?

    • “The study found that obesity is associated with about two per cent of Alzheimer’s cases.”

      One fun thing to do with statistics used to make pronouncements is to turn then around and see if they still hold true. If obesity is associated with 2% of Alzheimer’s cases, then it is NOT associated with 98% or cases.

      Given that the current claim is about 30% of the first world population is obese, I would say that shows a -protective- effect, ie. lower rates of Alzheimer’s among obese people.

      • OOOH! I just knew one of Ragen’s wonderful readers would have a great retort!


    • Man, both my grandmother and grandfather were incredibly physically active throughout their lifetimes, neither smoked, both went to college, neither had high blood pressure, nor diabetes, nor were they obese. My grandfather worked from sun up to sun down in the fields as a corn and soy farmer. He was strong and muscular and thin. He still managed to need a triple bypass at one point in his life. He also ended up with skin cancer due to being out in the sun all that time. In the end both my grandfather and now my grandmother have Alzheimer’s. Even now my grandmother is rail thin and her doctor is trying to get her to eat more because he says she is so thin it is unhealthy, but she is so afraid of gaining weight. I don’t get it. My cousin happens to be anorexic, as is my sister. My mother and myself are the only fatties in our family. It is weird how our various insecurities surrounding food and body image have managed to manifest.

  5. This post made me cry there at the end… it is so hard for me to remember to be myself, and not worry so much about being what others want me to be. You are an inspiration on so many levels!

    • Thank you so much! It’s hard for me to remember sometimes too, I write to remind myself!


    • Agreed! It’s blog like yours and Well Rounded Woman’s that have really helped me to ignore some of the crap that’s spewed out about the obese.

      And today especially, I have a reason to celebrate. According to many people, I should have failed in having my VBAC because I was obese. Obese women for many reason cannot have VBACs. The first hospital I went to did not want to even allow me a trial of labor because I would fail and in fact, was guaranteed to fail. Today is the one year anniversary of my SUCCESSFUL VBAC! I did it and I did it ignoring those punks who tried to tell me I couldn’t do it because I was “too fat”.

      • Congratulations to you, your body, and your baby!

      • Congratulations!

      • Congratulations and happy birthday to your little one!

      • Thanks for all of the congrats! It was quite a journey. I became pregnant while I was in South Korea with my husband. It didn’t take very long before I realized that staying there would not be a good idea (with a 3% obesity rate, Korean OBs are not at all equipped to deal with obese patients and I was the FIRST obese patient my OB had ever had). I returned to the US at almost 30 weeks and spent the next five weeks looking for a provider who would allow me a trial of labor. It wasn’t easy, that’s for sure! Someday I’ll post about the entire journey in my blog but it would take several posts to do so!

  6. Good for you. Don’t post a food log; there’s absolutely no need for anyone to know how you fuel your body and all the exercise you do.

  7. I’m not more than 20 pounds over what the charts tell me I should be. My sisters are different stories, yet they’re healthier than I am.
    Keep writing it, girl!

  8. Yay us, indeed. Your last paragraph reminded me of a Vladimir Nabokov quotation: “I don’t think that an artist should bother about his audience. His best audience is the person he sees in his shaving mirror every morning. I think that the audience an artist imagines, when he imagines that kind of a thing, is a room filled with people wearing his own mask.”

  9. This post confuses me a bit. It is one thing to say that you can be fat and fit, and not just fit but impressively so. But if you say that you eat a “normal” ( about 1650 calories for a woman your height and age) amount of calories, then you are claiming to be a medical oddity. At which point, I’m sure you would insist on a visit with your doctor, with a food and exercise log handy, and wouldn’t leave without a diagnosis of some kind. It’s just that, fat is energy storage, which cannot exist absent of energy. I know you know this, and i am sure I am just misreading or missing the point, But I just want to be clear that you are saying that you can be fat and healthy, by exercising regularly and by eating several thousand more calories than the “recommended” amount each day, if those calories are from a nutritious source.

    • Hi Barbara,

      I’m saying that calories in/calories out is an oft-repeated gross oversimplification for the way that the human body works. Based on my lean body mass, caloric intake, and exercise I “should” lose weight, but I don’t. I covered this in detail here:



    • Any more of a medical oddity than those who eat and eat and eat and can’t gain a single pound? I mean, my husband and I can both miss a meal or even two meals. He’ll lose weight. I won’t. He’s 5’6 and weighs 130 lbs. I’m 5’5 and close to 300 lbs. I know people who weigh far less than me who can put away tons more food than I can but not gain a single thing. Why are they not seen as medical oddities?

    • And this is why I thought that we might benefit from Ragen keeping a food log. I certainly don’t think she has anything to prove (quite the opposite, and I don’t feel that I worded things well in the e-mail), but I do think that “calories in, calories out” is a fallacy. Until we have people who stand up and say in a reasonable manner that their bodies just don’t work that way, folks will continue to believe it (and will continue to starve themselves and overexercise in a futile attempt to “earn” negative caloric balance).

      I absolutely respect her right to not do so if she chooses, though.

  10. Yes, People with extremely fast metabolisms are medical oddities. Those people are incapable of holding onto fat storage no matter how much they eat, I am just asking if Ragen is also claiming to be a medical oddity ( which is fine, i’m not attacking) I have an extremely low resting heart rate and double joints, and all sorts of little intricacies. It would just be ridiculously helpful to the health at every size cause If we could get someone like Ragen, to start a documentary.
    If she could get a group of morbidly obese women who are physically active, internally healthy, who eat the recommended amount of calories for their height and age, really document it, and put it out there, it would blow people away. Ragen is an Activist. And unfortunately being an activist has to come with a certain amount of disclosure. You can’t say ” take my word for it” When the entire medical community says here are our logs, documentaries, studies, statistics, photos, and staggering evidence. Ragen has put a lot of time, work, and emotion into her cause. It ain’t easy being an activist =)

    It’s not WRONG for people to want all the information that they can get. Americans especially buy into ” fat is unhealthy” Because every time they check their e -mails there is a new article from a respected medical journal saying that it is…but also listing the numbers, the details of the studies, the details. ( no, i’m not saying that every article has full disclosure or is infallible) Let me repeat: Wanting all of the information and asking for it isnt wrong, it’s wise.

    • I, for one, would love to see such a documentary. Hmm. I have a friend who’s a documentary film maker. I think I’ll pitch the idea to her.

      This being said, I’m not so sure that people want all the information. What they *do* want is to have their biases and prejudices confirmed. That’s why they love shows like The Biggest Loser and that A&E show (the name escapes me) where two people spend six months at a fat camp losing massive amounts of weight.. Viewers want to see confirmation that all fat people are pigs who are entirely responsible for eating themselves into the hole they are in. Indeed, most of the weight-loss blogosphere is in this camp.

      A documentary on fit, fat people would just make most viewers say:
      “Yes, but when the camera is turned off, it’s obvious she goes and stuffs her face,” or “it’s only a matter of time before she develops diabetes, high blood pressure, needs a knee replacement,…”. This is what Ragen so eloquently calls the “vague future health threat”.

      In short, there is no convincing the brain-washed majority.

      I still want to see this documentary though! Is this “vague future wishful thinking”?

      • Yep, exactly. A documentary wouldn’t satisfy the fat-shamers or concern trolls. Even when stories are done on fit fat people, such as the marathon runner who is also a wrestler (and completed this marathon at 400 lbs, something I sure couldn’t do), people still chastized him and one said he shouldn’t be moving at all at his size. You can’t win with people like that.

      • I would be open to doing a documentary (hint, hint…call me 🙂 not to prove anything to people who don’t believe me. Just so that people who look like me could see someone who likes like them on film. We are largely absent from film and when we are present we are typically awkwardly quirky, in low-paying jobs, pathetic, unathletic and desperately seeking weight loss. I would love to show (or see!) a very fat woman who is the CEO of a corporate conglomerate and a National Champion Dancer in the movies, but it’s not about “proving something” to the majority. It’s about the minority – it’s hard to have a civil rights movement when many people in the oppressed class believe that they deserve to be oppressed. I’m much less concerned that random people think that fat people deserve respect and much more concerned that fat people understand that they are worthy and deserving of respect.


      • I’ll put in another vote for the doc! Could we get Michael Moore to do it? People actually listen to him even when he tells them things they don’t want to hear; he could expose the myths of the multi-billion dollar diet industry!!
        LOVE IT.

    • She has an entire blog entry on this:

    • We already have a documentary on this. It’s called “Ruby” and it’s been on the air now for far too many seasons. This woman has been given free food, free trainers, free counseling, she’s been followed around by cameras and crews for a few years now and is not only still morbidly obese but is gaining weight back that she lost and unable to lose anymore. I know this only because one of the geniuses that I went to high school with complained on her facebook page about the show, calling Ruby a failure and that the show should be pulled off the air. I agree with what Reagan has said. People are far too entrenched within their conditioning and biases to deduce anything from such a documentary except to turn to another channel if the subject is not being thoroughly abused for being overweight.

  11. I really heart those doctors who accuse me of lying in my food journal. Heart them a lot. Not.

  12. Here’s the thing. You can’t say ” I am a fit, healthy, proud fat person who has nothing to hide, and wants to share with the world that you can be fat and healthy” And then say ” No body will believe me if I put the information out there, so I’m not going to” You either believe that you are helping the cause, or you believe there is no changing peoples minds and you are wasting your time.

    Activism consists of intentional efforts to bring about social, political, economic, or environmental change. People will always say hateful and ignorant things, there are still people who don’t believe the holocaust ever happened for gods sake. But you should sleep easier knowing, that you have done everything that you can do, that the information is there if people want it.

    You post pictures of your excellent dancing, and your flexibility as proof, and you do that for a reason. You have sucessfully debunked ” fat people can’t move and don’t exercise” but you are just allowing them to say, ” well the woman must live on chili cheese fries.”
    I wish you could see the importance of representing your diet, as you see the importance of representing your physical stamina.

    Again, either there is the possibility that through diligence and education, one day, fat prejudice will be will be a thing of the past or “people don’t want all the information, they just want to hate, so why bother?”

    • There’s a bigger issue here, which is that fat prejudice isn’t really about health. It’s based on things like aesthetics and class. It’s permission to jeer at people who don’t fit the conventional aesthetic, under the guise of concern.

      Once people begin to produce their diets and exercise regimes for verification, they run the risk of colluding with the idea that people are concerned about fat because of its health implications. In a way, to offer lots of health information validates the implied health concerns – it’s saying “I know you’re concerned about my health, so here’s why you don’t have to be”, when the jeering and prejudice aren’t really about health at all.

      And, to be honest, everyone could produce a detailed list of their diets and it wouldn’t be believed. At least with exercise, you can offer photos, which are indisputable proof and cognitively disruptive.

      • It is necessary to post diet and exercise information not for the incurably prejudice who make statements like ” fat people deserve to be stung to death by bees” but for those loving, caring souls, who have no idea how prejudice they are. take this conversation, with probably, the sweetest woman in the world

        HER:” I always get upset when people are bad mouthing people for being fat. The thought that they are not as smart, or hard working, or that they aren’t taken seriously is heart breaking” ” I mean, it’s not like they are not trying, they just don’t know any better”

        ME:” What do you mean”

        HER:” Well for instance, I’ll be talking to one of my heavier friends, and they’ll say ” I ate yogurt and fruit with granola for breakfast, a salad for lunch, and chicken with steamed veggies for dinner”

        ME:”And that’s bad?”

        ” Goodness no, and that’s what I am trying to say. They think they are eating really well, but to put a bunch of dried sugared fruit, granola with chocolate chips, over cookie dough yogurt and add canned fruit cocktail in syrup, will make anyone fat!”

        ME:”I see”

        ” and a salad really means that they have a little bit of iceberg lettuce drowning in ranch dressing, bacon, cheese, and sour cream”

        THIS!! THIS is what is soooo upsetting. They don’t think they are prejudice because they don’t think they are making judgments…other than the judgment that We are fat people are all VICTIMS OF OUR OWN STUPIDITY
        I don’t think the majority of people want fat people to die horrible deaths because we are innately bad. I think the most common form of prejudice is represented in forms like the above.SO Yes, to say, THIS is what I put in my body, I do live a self examined life, and I do know whats best for me, will help facilitate change

    • This was my point, Barbara. That it’s necessary to show that obese people can and do eat as little as thinner people, just as Ragen shows that obese people do exercise. I think it’s important.

      • Heck, I showed my doctor exactly what I eat. I kept a food diary for four months. He looked it over and said to me, “are you sure you never just… buy a bag of potato chips and eat the whole thing?”

        he still didn’t believe me. When I wrote down every little bit of information. Every piece of food or drink that went into my mouth went into my food diary. And he still looked me in the face and called me a liar.

      • Melissa, I wonder if a simple thought exercise might be enough: Most people will admit to knowing/having known people who exercise less than they do or eat more or eat less healthfully than they do and are still thinner than they are. So if person B gains weight more easily than person A despite a healthier or as healthy lifestyle, why is it so difficult to grasp that person C gains weight more readily than person B (and A). It seems like this should be enough to consider that body size might be more nuanced than “calories in, calories out”. However, if you really want to present someone with evidence, you might be better off discussing the results of actual studies. One bloggers food diary isn’t nearly enough information to convince anyone of anything. I thought Gina Kolata’s book “Rethinking Thin” was really fascinating. There is a lot of information about what obesity researchers have already learned over the last several decades. You might be able to find it at your local library.
        Barbara, I’m a little confused. What you seemed to be arguing was the importance of fat folks tallying their food intake and offering it to I’m not even sure who for review. Yet you report a conversation with the “sweetest woman in the world” (!?!?) in which a heavy person recounts her food intake yet the “sweet ” lady remains convinced that the heavy friend is lying/stupid. While it is possible that every heavy person she has ever met was an uncontrollable glutton who put chocolate sauce and twinkies on everything, this really sounds like the wild imaginings of a diehard fat-phobe. I agree that the conversation you reported shows a common prejudice. I know I have heard variations of this as well. but I would characterize these “loving and caring souls” um…differently. Also, you do not owe anyone any kind of proof that you lead an examined life and know what is good for you. Neither does anyone else.

    • Hi Barbara,,

      Forgive my bluntness, but I find most of what you are saying in these comments crosses the line. It is not your job to tell me what I can or can’t do, or what kind of activist I need to be, or what should make me sleep easier. I don’t owe anything to anyone, including but not limited to an explanation of my health, food, exercise or body. When I do things that challenge people’s stereotypes, it’s not because I’m obligated to do so, or because I feel that I’m obligated to because I’m an activist, it’s because I’ve chosen to do them the courtesy of helping them challenge their stereotypes. I think that what you are misunderstanding here is that my writing is not for people who disagree with me and this blog is not an exercise in persuasive writing.or an argument against detractors. I write for people who want to be supported or inspired or exposed to my point of view, not for people who want to argue with me.


    • There’s nothing to say Ragen has to be the only size acceptance activist. If you truly believe keeping a food diary is the way to go and can link me to yours, I’d be happy to read it. 🙂

    • I agree with Ragen’s decision not to post a food log.The problem is that it’s a red herring. There are so many ways to eat, she couldn’t win no matter what she posted. People would look at her food log and say, “oh, so THAT’S what she’s doing wrong- she needs to eat less carbs/more carbs/less fat/different fats/fewer calories/more protein/ cut out meat/cut out dairy and so on and so on…THEN she’d lose the weight!” And if they didn’t find anything “wrong” with the way she eats they’d assume she’s lying. Either way, it’s unlikely to convince anyone and it’s just a distraction from her stated intentions for this blog. Her blog is a haven for people living in a world of fat hatred(or any hatred) to retreat to and get a boost up and a pat on the back. Besides, what a pain in the ass to monitor your diet that closely! Takes me back to the days of dieting…who needs that hassle? Seems kinda anti-HAES. I’ve recently begun trying out a paleo diet, not for weight loss but to see what health benefits I may get from it. However, I’m not super strict about it and I’m not going to turn into a diet nazi about it. There is no single perfect diet for all humans, we are all individuals and one man’s medicine is another man’s poison. Unfortunately there are a lot of people who ARE diet nazis and I bet they would pile on Ragen’s food log like a ton of bricks. What would it accomplish?

  13. Not sure if you’ve seen this back home:

    I’m always skeptical when some scientist says this one specific thing ’causes’ obesity, while totally ignoring the multitide of possible causes/contributing factors. I totally get where you’re coming from that it is just lazy doctors taking one look at you and blaming it on the size of the body in front of them. I’m fat, no equivocations. I’ve had doctors tell me I was out of shape after walking into the office, tell me my joint issues were because of my weight (my physiotherapist said hypermobility), doctors tell me my bronchitis would have been helped if I was thinner. Mind you this was after the obligatory scale step where he had the affront to say ‘wow you’re heavier than I thought’ to which I replied ‘muscle weighs more than fat’.

    The fact that I’d had chest infections & colds that lasted months on end since I was a kid didn’t raise any red flags until I was in my thirties and was diagnosed asthmatic. I don’t want to have to have WLS but I don’t want to constantly be misdiagnosed. I want to be treated (in the medical sense) like an unwell person not a fat person. Grrr

    • But that one post from Junkfood Science regarding WLS and the show House talks a lot about how you need to become your own advocate even more because your body will be completely and permanently changed form the surgery and goes into just how well you need to know your own now UNIQUE body in order to make sure that the doctors deal with you in that level. So now, it’s not that you might simply be unwell but you might be unwell due to complications from your anatomy being changed by this surgery.

      • My husband had WLS and just had to have hiatal hernia surgery, possibly because he’s not handling his WLS properly and possibly could have more serious health problems as a result possibly than what they were saying before – his first doctor had just kept saying all he needed to do was lose weight – he changed doctors and his new one actually started focusing more on his health, which had gotten bad, and started giving him things to help him, such that actually his health had gotten better before he ever had the surgery, so that ended up not really being why he had it

  14. I really like how often you post…and the content…not just ranting and raving like I’ve seen on so many other body acceptance/health-over- weight blogs, but actual thoughtful narratives. And you’re not afraid to have a respectful debate or answer questions or even discuss things you might not believe in. I’ve had a blog for about 10 years now, and I’ve always encourage this attitude. I do love a good spirited debate that seeks to share but not necessarily dissuade.

    It may be that you’ve covered this aspect before and I just haven’t read it yet…so advance apologies for this question if it’s ignorant…but having just moved back here to the states after being overseas for more than a decade, I’m observing some very alarming trends, and that is as a nation, folks in the US seem to be getting heavier. So yes, there is an increase of obesity–you can’t really deny that–but it’s not necessarily a bad thing. At the end of the day, the science either way isn’t really clear.

    But with all respect given to HAES (and oh yes, I live by HAES…this fat girl does a LOT of hiking, including climbing Ben Nevis and the top of just about every European landmark you care to name)…do you concede that there are people whose obesity is causing their health problems?

    The reason I ask is because here in my new city I have seen more seriously, dangerously obese people having trouble walking or even getting in and out of doorways, puffing when they get up and down just one flight of steps, and it frightens me. Again, I realise one can be heavy and fit–I’d be a flaming hypocrite if I said otherwise–but do you agree or disagree that in some people, obesity can be a very dangerous thing?

    As I was reading your blog last night in my hotel lobby (we’re currently at a hotel as we’re waiting for our household goods to be shipped over…what fun it’s been) a woman came in who was so incredibly obese she could barely walk and was wheezing from walking the 20 feet from her car to the desk. Her legs were so big she had to walk with her feet spread far apart and could barely make it down the hall. I don’t like to play the Guess My Weight game, but she was easily 400 pounds. When I see a person like that, my first thought isn’t, “God, what a pig…” it’s “Something has gone really wrong there…maybe a chemical imbalance or lack of movement…” and of course the next logical conclusion was that if she lost some weight, she could at least walk easier. There’s no denying that part, and in this case, I am 100% convinced that her obesity was causing some of her problems.

    I respect your blog a great deal and have found great strength in reading it, so I hope you don’t take offense. I’m just curious because I find myself returning to a country I no longer understand, and this whole Fat Acceptance thing is very, very new to me.

    • Perhaps it is more difficult for this person to walk because of the fat they carry, but what if the person really can’t lose the weight? If there is a lack of movement maybe that person is in excruciating pain when they move? If it is a chemical imbalance, then what? I injured my back some time ago and it is impossible for me to stand for more than five minutes without being in so much pain I am in tears! I am just so lucky that my current doctor has gotten me in to see a physical therapist and the center I go to has such awesome equipment like the NuStep, which is a recumbent stepper. I just sit in it like a chair and I get to pump my legs, set the resistance to where I am comfortable, and go for as long as I can until I get tired. But what if I didn’t have access to that type of equipment?

      Heck, even my doctor has told me I would need to restrict my caloric intake to 600/day and work out like I was training for a marathon for me to see ANY weight loss. I am diabetic, I have a low thyroid function, there are plenty of other things going on. So far all the medications, the exercise, the diabetic diet (I am on 1600 calories a day because anything less than that and I am ravenously hungry. I have out right refused to go any lower on my caloric intake.) hasn’t done a thing to my weight. Although, the extra furosemide I have been taking for the severe edema has had me peeing off water weight like woah.

    • A person who is fat because of an underlying health problem, whatever it is, should be treated for that health problem. Maybe they would be happier, more mobile, if they lost weight, and that seems like an easy solution, but it isn’t. If 95% of attempts to lose weight fail, it seems like a very very difficult solution to implement. If they are fat because of this underlying health problem, it may be even more difficult for them to lose weight before the problem is treated. If they lost weight, yeah, they’d be thinner, but they’d still be ill. And if they’re out of breath on the stairs, is it because they’re fat, or because they’re unfit, or because they’re asthmatic, or have emphysema, etc, etc. You simply can’t judge someone’s level of health from their size, even when you look at someone and think, “oh, they’re unwell!”

      My mom has many of the symptoms you describe; unable to get up and down one flight of stairs, walk twenty feet from her car to the house; she huffs and puffs. She’s maybe a little “overweight”. Would you say that it’s her fat that makes it hard for her? No…you might assume it’s her age. Another way of looking at someone and guessing their health. But my mom has always had asthma, even when I was a little girl, and during certain times of the year, she always has trouble like this. She’s been fat and thin, and it’s made no difference.

      I’m not trying to be mean or tell you off, or anything, just put it in different terms. When you say it’s an “alarming trend” for people to be fatter, think about why you’re so alarmed. You say people are “dangerously obese”, ask yourself what is so dangerous about these people’s apparent health?

    • Yorkie: You might want to consider that medicine is improving continually. So there are people alive who suffer from illnesses which would have killed them had they been born twenty years earlier. Because of medical advances, not only can they survive, but they can be seen out on the street, living their lives. Some are wheelchair bound. Some take meds which mess up their metabolism. Some have their metabolism messed up by illness. Some of them are obese. These categories overlap.

      That woman you saw, she might be in the best state, health-wise, that she can be in. You cannot know. Which is why judging people by their looks is not a good habit to have.

    • The woman who used to be the administrative assistant in the nursing studies department at the community college I attended to get my LPN certification was extremely obese and couldn’t exercise because she had congestive heart failure. My initial thought too might be “if they lost weight they could move better” but I don’t think a person in such a condition really can concentrate on losing weight and it is better to concentrate on correcting the underlying problem which is making them unwell.

      • Before my husband lost weight they had also diagnosed him with congestive heart failure and put him on diuretics for it – what is furosemide?

  15. You are my inspiration!

    And I love all your posts. Even though the HAES focused ones sometimes make me uncomfortable because, well, I am not healthy.

    I was very active all through high school and especially in college. I was diabetic, but I was able to control it with diet and exercise. Lots and lots of exercise. If I wasn’t studying I was doing some sort of physical activity. I took step aerobics and lifted weights. I walked everywhere. I swam and biked and hiked. I’d go out dancing with my friends.

    But my diabetes progressed, as it usually does. And eventually I was on pills. And then I was on insulin.

    Unfortunately, I lost my medical coverage. And that’s when things started going down hill very rapidly. I went for nearly ten years as an insulin dependent diabetic without any access to medications. It really took its toll on my body. I now have extensive nerve damage, some minor changes to my eyes, and the worst of all, the gastroparesis. I can no longer eat like a normal person. And my first gastroparesis attack was in 2005. I have been in and out of the hospital ever since. Each time only serving to make me weaker. I have spent so much time bed ridden. It has been a real blow to my physical as well as emotional well being.

    On top of it all I have lost much of my sense of balance. I am told this happens to people who have been diabetic for a long time. I have lost so much muscle mass. I feel weak. I feel like a failure. I have been going to physical therapy to try to regain some of my strength and balance, but it is hard going. I can only bench press 12 lbs. I come home crying because I used to be so strong.

    I have recently been blacking out and falling. I injured my back pretty badly because of this. The doctor refuses to send me for an MRI and tells me I just need to lose weight. but I never had back pain before the fall. I don’t have any other joint pain or problems. It’s so hard to love myself when my body can’t do what I want it to do. I try so hard. I tell myself I will get better, but sometimes my end goal just seems like an impossible dream! But reading your blog gives me hope. I don’t think I can be as strong as you. I don’t think I can regain everything I’ve lost. But I hope I can at least get to a point where I don’t have to rely on my wheelchair anymore. So, thank you for your blog! And thank you for the kind words you’ve left me over at Facebook.

    • Your story is truly distressing. I have no words of wisdom to give you except to say that you are NOT a failure. Not at all. You have clearly done everything in your power to fight for your health.

      However, there IS a real culprit in your life. There IS failure–though not at all yours.

      The culprit, the failure lies with a health care system based on money and one’s ability to pay rather than on the principle that health is a basic human right.

      I’m not looking to open up a raging debate on health care but let me state, for the record, that universal health has proven itself time and time again to be the most cost-effective and efficient way to keep populations healthy. There are many version of UHC, and there is no absolutely perfect system, but the patchwork private system in the States has shown itself to be disastrous for a significant proportion of the American population.

      • my daughter in law has gone through the same thing – she was a “Medicaid child”, if you will – I think I’ve come to decide that’s one of the greatest injustices done to our children – we take such good care of them as children but then when they “age out” and become adults we take it all away – I guess I understand that they’re then supposed to be able to go out and get a job – with insurance – but that’s not always that easy, especially when you have health problems and then especially when they’ve been being treated and now are no longer able to be because of no longer having insurance – like you, without debating this whole health care issue – but the Affordable Health Care Act has at least been a blessing for her – don’t know if this will take care of everything but she’s just had her gall bladder out

  16. Speaking of correlation…

    • Well, booger!! At 6′ and 365 lbs, I guess I’m just hosed!! 😉

  17. First off… Thank you so much for writing this blog. It has made me much more confident and comfortable with myself, I’d already started on the journey as my friends are very supportive and accepting, but you have given me resources and terminology to help me frame my decision in a way that makes it hard for people to argue with me.

    Secondly, I think posting a food journal wont change the mind of the people who don’t want to believe.

    I have been told, by my mother, that I must be deluding myself about what I’m eating if I’m not losing weight. If I can’t even get my mother who struggles with her own weight to believe me, how can we expect people who just want justification for their hate to believe anyone.

    Those who want to believe will look at the rest of the evidence and start looking for their own proof, those that don’t will just call liar and claim they are right anyway.

    As an interesting aside I’ve not been paying any attention to my weight this year, but have made an effort to be more fit and active. When I finally got weighted after 6 months of not focusing on it I’ve come down enough to placate my mother a bit. I’ll continue on the same way and let my body do what it wants while I get fitter and, hopefully, healthier.

  18. I love your writing – we *need* essays like this (whereas, a food diary would be very dull reading!) 🙂

    • When I start reading a blog and realize that it’s just an excruciating tally of food, points and/or calories, sometimes accompanied by pictures…I’m outta there.


  19. This is my new absolute favourite post you’ve ever done darlin!

  20. You are and continue to be amazing. Thank you!

  21. As for the whole “anyone who is fat and eats a relatively low number of calories is a medical oddity” nonsense, this study alone is an adequate refutation. Putting children on diets is a great recipe for ensuring they have a high body weight in future; in fact, maybe that alone could account for the “obesity epidemic” (which I put in scare quotes considering that obesity levels have stayed dead even in the US since 1999).

  22. Adding to your list, for completeness’ sake: The health issue could be caused by obesity and it would *still* not be anyone’s business (except the person whose body it is and those who that person decides to consult about it).

    I see people who are fat and who eat a lot more than they “should”, and apart from it being not my business, considerations like “I cannot afford to become weak or dizzy because then bad things will happen” are perfectly valid and responsible.

    As you have said so well in another posting, we have no moral duty to be healthy. In real life, one needs to priorize, and to be able to always priorize one’s own health above all other demands is a sign of extreme privilege.

    Also: Requesting the posting of a food log? I don’t even know where to start. What makes people think they got the *right*? Do they want a bathroom log too? Is gram-counting disordered eating the new black? On what planet does it make sense that someone has to make any stranger on the internet the judge of their ritual purity?

    And this ci/co is as useful as snake shoes, because we cannot measure co without locking a person into a closed lab where the very air they breathe is weighted — and ci is even harder to quantify. You cannot exactly predict how much fuel your car will use on some random trip. What makes anyone think that it’s simpler for people?

    Sorry, not my blog and not my place to rant, but the mind, she boggles.

    • Just out of curiosity: “…we have no moral duty to be healthy….” No, I suppose no one does. And a commenter before you criticizes our healthcare system and the way healthcare is (or isn’t) paid for. I see the problems with our system as well, and I’ve worked in it for over 17 years. But according to your philosophy, people can just let their health deteriorate in all the many ways it does (whether related to obesity or not), and in the end we ALL have to pay for it, even those of us whose health is important to us and who do put in the effort to be healthy.

      • Hi Jacqueline,

        That’s how the system currently works. I have to pay for people who smoke, drink, have motorcycle or bungee jumping accidents etc. and I’ve never participated in any of those behaviors.. How would you decide how much effort was enough to receive health care and how would you measure it?


      • Jaqueline,

        we are all going to die, And most of us will go through a period of detoriating health before we do, not matter how big, small, active, sedentary, risk-loving or risk-avoidant we are. Ill health is unavoidable, unless a person dies young, which we do not regard as an accomplishment. Shoving the responsibility to beat a basic fact of life at people is setting everyone up to lose, and heaps guilt on those who are suffering. That is neither humane nor reasonable. And if we are dealing with finite resources, calling those undeserving who have the greatest need won’t create a society I’d want to live in.

      • WOW. It kind of sounds like you don’t think I care about my health.

        If I didn’t care about my health and if I didn’t want to put any effort in to being healthy I wouldn’t be going to physical therapy twice a week. I wouldn’t be eating healthy, gluten-free, and organic foods. I wouldn’t be walking (even if it is only 4 minutes at a time, three times a day), or working out on the NuStep, or recumbent bike, or doing water aerobics. I wouldn’t be lifting weights (even if sometimes it’s only a 2 lb. dumbbell) and fighting through excruciating nerve pain.

        Up until recently I didn’t have the resources to eat healthy. I didn’t have the health coverage to go to physical therapy. I was sick. I was bed ridden. It wasn’t like I CHOSE that lifestyle. It was thrust upon me. And to suggest that my morals had anything to do with where I was for those years that I was lost and out of the system, that somehow if I had just pushed myself harder? Maybe I should have stolen insulin and syringes?

  23. I’m just not sure why anyone ever thinks suggesting that fat people demonstrate/prove/log their lives is an acceptable thing to ask. Would they do it if someone commented on their blog and suggested they should? However if it’s a fat person, people ask this of us all the time!

    I’m just boggled at why the entire world thinks that bodies and health are anyone’s business?

  24. Ragen, I love your blog and enjoy every one of your posts I have read (For a given value of ‘enjoy’…am made to think, am moved, am saddened, am amused may be more accurate) and I feel that reading your blog has helped me to become less judging and more accepting and understanding at least in my own internal judgy processes, but also in my words and writing. Thank you.

  25. I. Heart. You. You are an inspired human being.

    • Thank you so much. I Heart You Right Back 🙂

  26. Ragen,

    I want to express my deep support for your decision not to post a food log and my confusion about the controversy it seems to cause. I also personally would support you if you chose not to post your weight/height/stats of any kind because they are personal and truthfully, you have nothing to prove. That information is important for you to know and in some cases your doctor but otherwise it’s not really any of our business. I think your words are true and powerful regardless of your “numbers” (and why are we playing the number game at all?).

    Also, I just don’t understand what people think would be gained by seeing your food log. It just reinforces the idea that food/weight/health need to fall into some predetermined category and that they should be the same for everyone. What if your food log looked exactly like someone else’s food log but they were unhealthy by objective measures, does that make you unhealthy? What if your food log showed you ate more kcal than someone else, does that mean they are healthier or vice versa?

    I don’t think it means anything. Your body is different than other people’s bodies. What is “healthy food?” What does a “healthy diet” look like? What is a “normal calorie intake?” The whole point of HAES – specifically intuitive eating – is that the only way to determine healthy behaviors is by listening to YOUR body’s needs and no one can know what your body needs except you.

    If you feel healthy and enjoy your life and move the way you want to and eat how you want, then you’re doing the right thing, in my mind. I don’t know how seeing a food log would contribute or detract from your own personal experience, which is the only thing that can tell us anything about your health.

    Besides, I wouldn’t want someone to see your food log and think, “well she’s healthy and I want to be healthy so I should eat just like her!” That’s ridiculous. What’s right for you is not necessarily right for someone else.

    What if you kept a log of how often your breathe or hydrate or use the bathroom? Since you, by all accounts, are a healthy woman, should we all adopt your daily schedule of bodily functions?

    Judging someone else’s food intake is just as ridiculous, in my opinion.

    • Thank you so much for the support, I really appreciate everything that you said here, especially the bit about breathing, hydration, restroom habits etc.


    • This! I really, really don’t get the sometimes rabid requests that Ragen (or any person really) prove her “worthiness” through logging a food diary.
      Since my days of borderline disordered eating I refuse to keep a food log unless it’s to check to see if I have a food sensitivity or other very serious medical issue. And then it’s no one else’s business but mine and my health care provider.

  27. Just read this and loved it. I realize it was written in 2011, but it is perfect! No we do not have to prove anything to anyone, ever. We are who we are and that is a beautiful thing. I have been reading your posts for over a year now and love all of them! Thank you Ragen.

  28. Ragen, I’ve been reading your work for a few months now, and am so thrilled to have found it. You are so absolutely spot-on with this post. I’ve been moved by a lot of your writing, but this one, in particular, is just freaking brilliant, and is leading me to leave my first comment on your blog. I was going to call out a couple of specific quotes that really emphasize how powerfully insightful and just plain *right* you are, but the fact is, if this was on paper, the whole darn thing would be highlighted, because it’s *all* important.

    I wish more doctors, nurses, dietitians, nutritionists, and just plain laypeople had *any* clue about how this works. Most people are so completely ignorant of the larger forces at work in HEALTH, and the focus on weight is totally counterproductive, because it sweeps aside the myriad *other factors* that go into health besides someone’s pants size. I’m a nutritionist myself, and I know firsthand that being “thin” does NOT AT ALL mean someone’s healthy. In fact, they tend to be *more* UNhealthy than heavier folks. They’re happy with what they see in the mirror, so they give little to no thought to what they eat or how they move. Never mind their indigestion, mood swings, severe PMS, chronic pain, fatigue…but hey, they “look fine.” It is infuriating.

    You’ve addressed things so eloquently and intelligently here. This should be required reading for first-year med students…and then required for continuing education credits every year thereafter!

    I wrote my own take on the issue, but I indulged my anger and frustration much more than you did here. 😉

    Okay, I can’t help myself. I have to tell you how much I love, LOVE these:



    “I’m not saying a causal link is impossible, I’m saying that it’s not proven and that nobody seems to be too worried about finding out because they are too busy yelling “IT’S YOUR FAULT FATTY EAT LESS AND EXERCISE MORE!!’ YES!! I want Every. Doctor. Everywhere. To read this. I hate to repeat the word “infuriating,” but it’s really the best one for what’s gone on in medicine and research for the past several decades. (Or maybe mind-boggling? Disappointing? They’re all applicable.)

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