So I guess this is my version of a Fat Acceptance 101 post. A long talk with a friend over February break helped me sort out most of the thinking, and then an "I believe in HAES but I want WLS because I'm in pain and weight loss will fix it" post and the numerous pro-WLS and WLS-accepting replies thereto -- in a purportedly HAES online group -- motivated me to write it out.
When you strip away the siren song of a cure for whatever ails us (whether that be physical pain, mental pain, disability, etc), this all remains true:
1) Medical science has NO CLUE whether being less fat actually confers the health benefits medical science associates with being less fat, because very little research has been done that effectively proves causation rather than mere correlation. (In other words, we don’t actually know if being thinner is healthier than being fatter.)
2) Medical science has NO CLUE whether making a naturally/genotypically fat person into an artificially/phenotypically less fat person (whether via typical "diet and exercise" or more intensive surgical means) actually confers the health benefits associated with being less fat. (In other words, even if being thinner is healthier than being fatter, we don’t know if that is because of the thinness itself or because of other genetic factors. We don't know if becoming thinner through external means will make you as healthy as a person who is naturally thin.)
3) Medical science has not identified ANY weight loss interventions that are proven by good quality studies to be effective in the long term for more than about 5% of people. This includes WLS. (In other words, even if becoming thinner is healthier, WE DON’T KNOW HOW TO MAKE PEOPLE THINNER. This is key.)
4) Medical science does NOT fully understand the human metabolism and the complex mechanisms by which our brains, hormones, enzymes, digestive system, and other body systems regulate how our bodies use and store the energy we take in. (In other words, it’s no wonder intentional weight loss doesn’t work – we don’t even understand the body systems we are attempting to control!)
5) What medical science DOES know is that our bodies adjust how efficiently we use energy, when and whether to use energy versus store energy for later use, and so on, based on how much energy we take in, how much energy we expend, and who knows how many other variables. (In other words, our bodies are not the same as car engines. The whole “just eat less and exercise more” mantra is fundamentally flawed, because our metabolism is constantly reacting to changing circumstances and changing how it processes fuel accordingly.)
6) Because medical science does not comprehend how to adjust the human metabolism, WLS works on the same general principle as weight loss interventions (giving the body less fuel so that it uses energy from stored reserves, e.g. body fat) but depends on a physical impediment to the body’s intake of fuel rather than a behavioral impediment. (In other words, WLS is just a weight loss diet with a “gun to the gut” in the form of some sort of physical implant or mutilation of the organs that inhibits the body’s ability to eat much volume and/or to absorb the nutrition from what is eaten.)
Yes, it is logical that some of our afflictions may be caused in some way by our larger bodies, and the wear and tear to joints and body systems caused by asking them to work hard transporting our eloquent poundage through life. But given all of the above, it seems clear that this is moot. Intentional weight loss is not an option. WE DON'T KNOW HOW TO MAKE FAT BODIES SMALLER. Diets don't magically work just because we are in pain and are doing weight loss "for our health." Biology doesn’t understand intent.
If we want to feel better, we need to focus on things we can control: eating food that feels good and provides us energy, moving our bodies in ways that build strength and stamina, and getting psychological and emotional support to process the complex and difficult emotions that come with living in pain, living with disability, and being a member of a marginalized and oppressed group in society.