“Fat Acceptance,” Address, Rekha Nath.

Aug 7

Rekha Nath recently published a book, Why It’s OK to Be Fat (Routledge, 2024). The book critically engages with dominant narratives concerning how our society approaches being fat. After raising problems for popular anti-fat narratives, Nath offers an account of how we should instead approach fatness. The piece below is a talk that she gave at Jacksonville State University’s Spring 2025 Kaleidoscope public humanities lecture series. It draws significantly from the book.

Fat Acceptance: An Address

Introduction

My topic is fat acceptance. I am interested in reflecting together on how we think about, feel about, and talk about being fat.

In what follows, I’ll frequently use the term “fat” in describing some people and their bodies. That term may sound jarring to the ear, eliciting discomfort in us. All too often in our society, “fat” is used as an insult, a putdown, a condemnation of a body. When someone asks, “Am I getting fat?” or “Do I look fat in this dress?” we tacitly understand that being or looking fat is a bad thing. And so, we might be quick to reassure a friend: “No, of course you don’t look fat. You look great!” I won’t be using the term “fat” in that conventional way with an implied pejorative judgement. Following scholars and activists who write on anti-fatness, I will be using the term as a neutral way of describing larger bodies and the folks who have them.[1]

I became interested in this topic—in the anti-fatness that pervades our culture, or, as some put it, “fatphobia”—several years ago when one of my favorite radio programs, This American Life, had an episode on fat-shaming. The guests on the episode included feminist writers Lindy West and Roxane Gay who spoke poignantly about their experiences as fat women living in a decidedly anti-fat society. They discussed the humiliations, hostilities, and difficulties they regularly face navigating a society in which bodies like theirs aren’t seen as acceptable.

In the 2010s, talk of “body positivity” was seemingly ubiquitous. What had formerly been a fringe movement suddenly appeared to be surging in popularity. Advocates of body positivity affirm bodies of all sizes and shapes, and they push back against rigid beauty ideals, which among other things only deem bodies that are thin and muscular in just the right ways as attractive. Revolting against this narrow ideal, droves of women posted pictures of themselves online beaming, carefree, and fully enjoying life in bikinis with their fat rolls and cellulite on full display for the world to see. More celebrities, perhaps most notably Lizzo, became vocal in calling for greater inclusivity in the body sizes and shapes that we celebrate. Increasingly, fat-shaming was being denounced in mainstream public discourse.

Yet, all that co-existed with a steady barrage of public health messaging about the dangers of being fat. We have long been incessantly warned about the dangers of weight gain, and we have been told that unhealthy lifestyles—poor diets and too little exercise—are taking a devastating toll on our nation’s health. More recently, we have entered the age of Ozempic, in which a new class of injectable weight-loss drugs, GLP-1 agonists, are being heralded as a silver bullet to at long last cure our society of the malady of excess weight.[2]

Of course, the anti-fat messaging that pervades our social landscape is not just about controlling our body size for the sake of health. It is as much about how we look and the social rewards that go along with having a normative body. We want to look good, to be sexy, to be beautiful, to be handsome, to turn heads, and to be attractive to romantic partners. And so, we strive to be slimmer and more toned. We seek to bring our bodies closer to that elusive ideal physique as per our culture’s exacting, near-impossible standards. Our characters too come into play. To avoid being fat, we are taught that we must exert discipline in our lifestyle choices. The pursuit of thinness thus becomes a moralized endeavor. We must work hard for that perfect body. The multibillion-dollar weight-loss industry and countless wellness influencers capitalize on this desire for thinness that has been instilled in us, and they exploit it to get us to chase after the latest diet or fitness trend or weight-loss supplements or drugs that are on offer.

Perhaps I have painted a picture of how we find ourselves at a cultural crossroads with respect to social attitudes about fatness: that although plenty of anti-fat sentiment persists, we have moved in the direction of become more accepting of a diverse range of body sizes and shapes. However, on reflection, I think the notion that we are at any such crossroads is largely illusory. At most, the dial has shifted ever so slightly in the direction of fat acceptance in recent years. Yet, the vast majority of us don’t believe that it is OK to be fat.

When I first became interested in this topic, I had a modest goal. In the first instance, I wanted a better personal understanding of what to make of our cultural antipathy toward fatness. I am a social and political philosopher. My research and teaching centers on questions of social justice. That is to say that I theorize about how we should treat one another and strive to organize our collective life together. I consider the actual ways in which we fall short of our professed ideals, and I ask what realistic social progress looks like. In the case at hand, I wanted to interrogate anti-fatness and to ask how we should think about and talk about being fat.

The title of my book, Why It’s OK to be Fat, signals to you the position on this issue that I (eventually) came to take. I am well aware that my stance is a provocative one. The typical reaction I get when I tell people that I work on fat acceptance tends to be some mix of confusion, skepticism, or pushback. This ranges from the polite, “Well, that’s a controversial topic!” to the “But you don’t really think it’s OK to be fat, do you?” to downright dismissal or ridicule of the proposition that it could be OK to be fat.

This brings me to my aim in the rest of the talk. I will be making the case that once we clarify just what it entails, fat acceptance is not a radical or misguided ideal. In fact, it is an ideal that we should all embrace. At least that is so if we care about people’s health and well-being, as well as about treating all members of our society with basic respect and dignity. Before getting to fat acceptance, I want to spend some time reflecting on one important dimension of how our society, at present, is decidedly not accepting of fatness and how that affects all of us.

The Dominant Paradigm

Let us turn to what I’ll refer to as “the dominant paradigm” concerning how our society approaches body weight as a public health issue. I will present the dominant paradigm without endorsing it. We can start with some basic facts. On this paradigm, which has been in place for at least the past thirty years, high and rising rates of “obesity” and “overweight” are framed as a public health crisis. These classifications are based on body mass index (BMI), which is a measure of a person’s weight relative to their height. If a person’s BMI places them above a healthy or a “normal” weight, then they are further classified as “overweight” or “obese” depending on how high their weight is.

We are told that our nation is in the grips of a public health crisis because over the last half-century Americans have been getting bigger. At a population level, it is true that we have gotten bigger. The obesity rate for adults is about 42% today, nearly three times higher than it was back in the 1970s. Currently, over 70% of American adults are either “overweight” or “obese.” This is seen as cause for grave concern because carrying “excess weight” is linked to a range of serious health conditions—heart disease, type-2 diabetes, and several types of cancer.

On this paradigm, in one sense our nation’s “weight problem” is seen as a simple problem. We are fat because we eat too much and move too little. In light of this, the remedy too is seen as quite straightforward. To avoid being fat, we must eat less and move more. This is the “calories-in-calories-out” refrain that we have all heard plenty of times. Fat-avoidance is framed as common sense. It is about showing some restraint and not indulging in Krispy Kreme donuts or McDonald’s on a daily basis. It is about regularly going to the gym and resisting the impulse to spend most of our free time lying on the couch glued to our device of choice.

However, there is another sense in which it is acknowledged on the dominant paradigm that addressing our nation’s “weight problem” is not so simple. After all, if it were we might expect to see obesity rates decline as alarm bells have been raised about this crisis for decades now. But they have not declined. Instead, over the years, obesity rates have been incrementally rising. That is the case in the United States. It also appears to be the case in just about every country worldwide that tracks these trends. Obesity rates have been on the rise in most societies, and nowhere in the world have they meaningfully fallen in recent decades.

This brings us to the sense in which this problem is seen as quite vexing on the dominant paradigm. Despite knowing just what people need to do to avoid being fat, the tricky part of solving the problem, it is thought, is a matter of uptake: How to get more folks to embrace healthier lifestyles that go hand-in-hand with achieving a healthy weight? Put otherwise, we know what people need to do, but we don’t know how to get them to do it. For decades now, folks in public health have embraced a three-prong approach to the uptake issue.

First, we monitor. We continually and vigilantly track people’s weight to ensure that anyone who is above a “healthy” BMI is made well aware of that fact. Just about anytime we go to the doctor’s office, whether for an earache or the flu, we are prompted to hop on the scale. In over half of the states in the U.S., schools are required to screen students’ BMIs (in some of those cases, parents also receive a “BMI report card,” notifying them of their child’s weight status).[3]

Second, we educate. We ensure that the public knows in no uncertain terms the great dangers of being fat and precisely what they must do to avoid being that way: again, eat less and move more. In 2023, the American Academy of Pediatrics (a group that is highly influential in shaping pediatric clinical practice in the U.S.) released new revamped guidelines on addressing childhood obesity.[4] They suggest that fat children from ages six through twelve (along with family members) enroll in intensive lifestyle programs that meet weekly, ideally for six months to a full year. These programs are geared toward instilling healthier lifestyle habits in these children. They teach healthy habits with an emphasis on hands-on learning: for instance, introducing enrollees to new healthy foods and to various fun physical activities suitable for different fitness levels.

Third, we employ various tools of social pressure. Basically, we put the lean on people to make “better” lifestyle choices. This often goes hand-in-hand with education efforts. For instance, the aforementioned intensive lifestyle programs recommended by the American Academy of Pediatrics are about educating but also motivating children and their families to make behavioral changes. Plenty of workplace wellness programs employ tools to encourage employees to achieve and maintain a “normal” weight by following the prescribed behavioral advice of curbing calories and moving more. Many American workplaces provide small financial rewards (e.g., a $50 gift card) to employees who have a “normal” BMI. Employees may be eligible to receive free or discounted Fitbits or like devices that gamify wellness by nudging users to stay below daily calories limits or achieve daily fitness goals. Social pressure takes more aggressive forms as well. For instance, Georgia’s “Strong4Life” campaign against childhood obesity featured fat children and adolescents in video commercials and on billboards accompanied by captions disparaging their fatness (“Big bones didn’t make me this way, big meals did” and “WARNING: it’s hard to be a little girl if you’re not”).[5]

The public health message grounded in these three prongs has been more or less the same for decades now. Broadcast in clinical settings, schools, workplaces, public health campaigns, and by the media, it is conveyed to the public with great urgency that we must address our excess weight by changing our poor lifestyle habits. We variously emphasize low-fat or low-carb, or focus on simply cutting calories, or counsel people to track their protein intake or their “macros.” There is intermittent fasting, Paleo, the “75 Hard” challenge, and HIITs, and CrossFit, and the list goes on. Importantly, however, we do not stray from the core idea that we must combat our society’s weight problem by finding ways to get people to eat less and move more.

As I see it, it is high time for a paradigm shift. The way that we currently approach weight via the dominant paradigm is not helping and, indeed, is harming us. Being the dominant paradigm, its key tenets are accepted by most as common sense, as obviously true. So, the suggestion that we should abandon it challenges us. In what follows, I strive to lay bare some key flaws of the dominant paradigm.

Problem #1 It Isn’t Improving Our Health

Let us turn to the first problem with the dominant approach. It isn’t working! What do I mean that it is not working?[6] It is not just that rates of overweight and obesity have not declined as we have been waging a sustained campaign against obesity for well over thirty years now. They have been steadily rising. What is more, the core imperative of the dominant paradigm—eat less, move more—is not working because it is based on a falsehood. It is just not true that we know precisely what individuals need to do to avoid being fat. Not in a practical, workable sense anyway. Let me explain. Consider that most people in our society who are fat (and plenty who are not fat too) have tried to lose weight and have tried multiple times. Numerous studies carried out for over half a century reveal the same finding: attempts at losing and keeping off much weight do not succeed in the long term. By most estimates from these studies, upwards of 90% of dieters do not lose and keep off much, if any, weight in the long term. It does not matter which diets or exercises routines they engage in to facilitate weight loss or maintenance.

Attempts to lose and keep off substantial weight over time follow strikingly similar trajectories in most people. Most people who try to lose weight—through dieting, exercise, or some combination of the two—tend to lose weight over the initial few months of their weight-loss attempts. Then, somewhere around the three- to six-month mark, most people hit a plateau. Despite trying to lose more, their weight does not reduce further. Then, as more time passes, they begin to regain some of the lose weight. Over the few years following a weight-loss attempt, most dieters regain the majority of the weight that they lost. A significant proportion of dieters end up heavier than before. In fact, rigorous studies that compare two groups of people who start out at similar weights find that dieters end up weighing more, on average, than non-dieters in the long term. To be clear, these empirical findings are neither disputed nor obscure.

For decades now, public health scholars and clinicians have widely acknowledged that a feasible best-case scenario for most larger individuals trying to lose weight through lifestyle changes is to lose and keep off around 5% of their initial body weight in the long term. This is considerably less weight than most people who are told their BMI is too high would need to lose to reach a “healthy” weight.

The bottom line is that the mantra drilled into our heads that we must eat less and move more to attain a body of the “right” size has not done good by its own metric of success: that of producing a much slimmer population. The dominant paradigm has it wrong. We are not dealing with a simple problem for which we have a ready solution at our fingertips. Studies confirm what is already plain to most of us. Namely, that a vast majority of Americans want to be thin. Most everyone who is fat is keenly aware of their being so, and most of them have tried multiple times to lose weight through diet or exercise. Put otherwise, then, we are getting plenty of uptake, but that is not producing the results that it is supposed to.[7]

Problem #2. It Is Worsening Our Health

This brings me to a different problem with the dominant paradigm. It is not just that dispensing the standard advice—i.e., telling people to eat less and move more to avoid being fat—does not work. Furthermore, it seriously harms our health.

As we have seen, central to the dominant paradigm is the notion that each of us, through our lifestyle choices, has meaningful control over our body size. Even in the Ozempic era, Americans continue to spend tens of billions of dollars annually on traditional weight-loss products and services (such as diet meals and beverages, fitness programs, and weight-loss programs and apps). Countless wellness influencers enjoy popularity and success touting the benefits of the latest diet or fitness trend that has changed their lives (which ultimately, of course, is a matter of changing how their bodies look).

The relentless flood of images valorizing thin and muscular physiques and of advertising and messaging urging us to follow various weight-loss or fitness regimens to attain the supposedly ideal physique can have profoundly damaging health effects. Since 2000, researchers have documented a rapid rise in eating disorders worldwide (their incidence has more than doubled among the general population in that time).[8] Globally, in recent years, researchers have found a high incidence among young people of disordered eating, poor body image, and an obsessive and unhealthy preoccupation with weight, diet, and fitness.[9] The uptick in these conditions and behaviors appears to be especially pronounced for adolescents and, in that cohort, has been linked to heavy social media use.[10]

Our society instills in us a fear of being fat from a very young age on. This internalized fear is particularly prevalent among girls and, later on in life, women. According to the National Eating Disorders Association, some “40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming fat.”[11] Among adolescent girls aged sixteen to nineteen, 45% tried to lose weight through dieting in the past year (a statistic that includes over one in every four normal-weight young women engaging in weight-loss attempts).[12] Regular dieting can serve as a gateway for developing a dysfunctional relationship with food, which can in turn evolve into a full-blown eating disorder.[13]

The most dangerous and deadly eating disorder is anorexia, which involves severe food restriction. Anorexia is now estimated to affect about two to three times as many individuals who are at, or above, a “normal” weight than those who are classified as “underweight” (when it affects higher-weight individuals the condition is called “atypical anorexia,” though the statistics suggest it isn’t atypical at all).[14] The devastation that starvation does to the body occurs whatever a person’s body size. The condition presents in near-identical ways in larger anorexic patients as in those who are smaller—they faint, they lose their periods, they lose hair, they suffer severe nutrient deficiencies, and palpitations and other heart problems. They are at heightened risk of major organ failure and death.[15] However, it has been so deeply ingrained in all of us that it is not a problem when people who are above a “normal weight” greatly restrict their food intake to lose weight (indeed, such behavior and related weight loss is often encouraged by those around them). That is likely a key part of the explanation as to why so many medical professionals fail to give this serious health condition due attention when it presents in their patients. Higher-weight individuals with anorexia are much less likely to get the treatment that they need. In a culture so singularly focused on fat-avoidance, we lose sight of the extraordinary destruction that the pursuit of thinness has on so many people.

Even for those who don’t suffer an eating disorder, the emphasis that the dominant paradigm places on a person’s own responsibility for their body size can do great harm. This narrative fuels a sense of deeply internalized body shame in millions of individuals who are told their bodies are too big. A majority of our nation is fat, and we know that most folks who attempt to slim down via lifestyle modifications do not become and stay thin in the long term. Under the dominant paradigm, these individuals are made to believe that there is something wrong with their bodies and that it is their own fault for not making better choices and not trying harder.

A considerable empirical literature reveals the corrosive effects of shame.[16] We know from study after study that making people feel bad about themselves for their body size worsens their mental and emotional health. Individuals who report feeling negatively judged for their weight experience higher rates of depression and anxiety, and lower self-esteem. Subjection to those experiences also harms physical health. Making people feel ashamed about their weight frequently causes a person to experience higher levels of chronic stress, and chronic stress is a known driver of disease—including some of the very diseases linked to obesity, such as heart disease.

Perversely, making people feel bad about being fat is correlated to lower adherence to those very lifestyle choices that society insists that we should all be engaging in. Studies show us that fat individuals who feel ashamed of their size are more likely to binge eat and less likely to exercise, especially in public spaces where they are frequently made to feel self-conscious or unwelcome.

A final way that the dominant paradigm worsens our health concerns how its emphasis on personal responsibility drives anti-fat bias. Anti-fat bias is a matter of negative attitudes about fatness, which are widely held by most people in our society, consciously and subconsciously. We have all been culturally conditioned to view fatness as a bad thing and to view it as a failure to exert appropriate self-control. These biases translate into negative treatment of fat people in healthcare settings. Studies indicate that 69% of doctors and 46% of nurses report biased attitudes against “obese” people.[17] Physicians report having less respect for their “obese” patients than normal-weight patients and believe that caring for them is “a greater waste of time.”[18]

It is not uncommon for healthcare providers (including those specializing in “obesity”) to describe “obese” individuals as lazy, stupid, non-compliant with treatment, lacking willpower, and undisciplined. Studies also reveal that such anti-fat biases influence how physicians interact with their fat patients as compared to thin patients. They spend less time with them in appointments. They provide them with less education about health. One study that analyzed over two hundred audio recordings of doctor-patient interactions revealed that doctors demonstrate less warmth and have less emotional rapport when interacting with larger patients.[19]

Frequently, medical clinics and hospitals lack gowns, exam tables, beds, and equipment ranging from MRI machines to simple blood-pressure arm cuffs that fit larger patients. Horror stories abound of doctors failing to sufficiently explore and diagnose medical problems of fat patients that have nothing to do with their weight—not running tests or performing procedures they would for a thin patient presenting with the same symptoms, instead telling them to come back after they have lost weight. It should be little surprise, then, that larger individuals are more likely to avoid healthcare settings—for instance, delaying routine cancer screenings and annual physicals.[20]

Taken together, these harms to people’s health are profound. From what we know, the dominant paradigm might motivate some people to adopt healthier habits, to lose and keep off weight, and to be healthier as a consequence. But, if we look at its effects on our population as a whole, there is every reason to believe that it is doing net harm to our society’s health.

Problem #3. It’s harming our well-being more generally

Besides worsening our health, the anti-fat bias that the dominant paradigm helps perpetuate does serious harm to our well-being more generally. Consider just a few examples.[21] In the United States, studies suggest that the number one reason that children and adolescents are teased or bullied by peers is for their weight, more so than for any other trait. Anti-fat bias also shows up in rampant workplace discrimination. Fat adults are less likely to be hired or promoted and are more likely to be wrongfully terminated than their thin counterparts. Fat people earn considerably less money than thin people. Weight-based discrimination in the workplace is especially pronounced for women. All of this is perfectly legal almost everywhere in this country (as well as worldwide). To take yet another harm, fat individuals frequently report experiencing everyday microaggressions, a common one being that friends, family, and total strangers criticize their food choices turning most every meal around others into a fraught, anxiety-inducing experience.

Plainly, our cultural obsession with thinness does serious harm. But looking beyond the evidence from the studies I have surveyed, we can reflect on harder-to-quantify harms our fear of being fat does. We might ask ourselves: How much of our lives, of our valuable mental real estate and our emotional energy and our time, do we spend worrying about what our bodies look like, about our distance from the near-impossible ideal? How many hours, weeks, months of our lives are lost to the enterprise of weight control—the calorie-counting, the weighing, the measuring, the tracking of workouts? What of the losses of lives put on hold—delaying dating, going on a vacation or to a party, wearing a swimsuit—until we reach some magical number on the scale that marks our worthiness? How do we even begin to quantify this toll? How much fun and creativity and meaning in our lives and sheer joy is sacrificed to these preoccupations and endeavors?

In my research, I came across anthropological accounts of societies in which fatness was a prized trait, a sign of beauty. I marveled at how I might feel about my stomach or my thighs had I grown up in such a society. Upon gaining some weight, how would it feel to greet a new roll of flesh on my body with delight not horror? But then I wondered: In such a society, might I just feel bad for not being fat enough?

This led me to imagine a different world, one that I ask you to try as best you can to make vivid to yourself. Imagine a world in which no one were judged for their body shape or size. Whether your body were slender, muscular, stocky, voluptuous, fat or whatever else would be something that others gave no more attention to than we do right now to whether a person’s earlobes are free or attached. Sure, we would notice those traits in others. But they wouldn’t be socially meaningful.

In such a society, what would change for you? I admit answering that question myself pushes against the limits of my imagination. I have no clue what clothes I would wear, how I would eat, how I would move my body, how I would feel about my body or about my weight going up or down. I have a feeling, though, that I would breathe easier, that such a world would be a friendlier, a freer space to inhabit.

I have argued that we should reject the dominant paradigm in light of the immense harm that it does. There are other problems with the dominant paradigm that I discuss in the book but won’t go into here. One that I will mention is that, contra the dominant paradigm, the relationship between weight and health proves to be anything but straightforward. Indeed, when it comes to the science of health and weight, the dominant paradigm relies on a slew of faulty generalizations, outright falsehoods, and oversimplifications of complex matters.

Fat Acceptance

In this final section, I want to turn to the matter of how we should instead approach body size. As I see it, we should embrace fat acceptance as an alternative framework. So, what exactly is “fat acceptance”?

Fat acceptance is at once an ideal and a moral imperative. At its core, it takes issue with the social disparagement of fatness and the marginalization of people with larger bodies. It calls for dismantling social barriers that deprive larger people of access to decent healthcare. It calls for an end to weight-based workplace discrimination. It stands opposed to the cruel and persistent bullying that fat children face. Likewise, it decries the thwarted potential of teenagers who obsessively work out and regularly skip meals out of fear of weight gain. It dares us to imagine a society in which a person’s claim to basic respect, dignity, and self-worth is not conditional on her body size.

Advocates of fat acceptance favor a “weight-inclusive” approach to healthcare. Such an approach prioritizes the reduction of fat stigma as an important public health goal in its own right. Unlike the status-quo “weight-centric approach,” a weight-inclusive approach to healthcare does not focus on the attainment of a goal weight for patients. Instead, it seeks to promote health for a person whatever her body size. This might involve finding ways to incorporate joyful movement into one’s life or finding tasty, nutritious foods that one enjoys eating (placing an emphasis on diet quality rather than quantity). Compared to the status-quo weight-centric approach, a growing number of studies suggest that a weight-inclusive approach produces better mental and physical health outcomes—including improved blood pressure and cholesterol, improved self-esteem and reduced rates of depression. Weight-inclusive health protocols also have greater success in eliciting positive behavioral changes in people when compared to traditional weight-loss programs. They have been linked to reductions in binge eating and disordered eating as well as increased engagement in physical activity.[22] All of these outcomes are linked to better health for a person regardless of their weight. So, this is an evidence-based approach that could meaningfully improve our society’s health.

Social progress is never merely about changing unjust laws, institutions, and public policies. It is just as much about changing deeply ingrained cultural norms. It is about you and me in our everyday lives, and how we think, feel, speak, and act. On this count, we might examine how fatphobia shows up in our own lives—trying to non-judgmentally tune into the myriad ways in which our own thoughts, feelings, words, and actions that relate to body size have been influenced by an anti-fat culture.

No doubt, a great deal needs to change for our society to become genuinely fat accepting. But we have reached a point where the evidence leaves us with little choice. The dominant paradigm is not serving us, and so we should let it go. It is high time for us to get on board with fat acceptance. It is hardly the radical ideal that it is sometimes made out to be. It offers us a clear path forward to improve our health and well-being, and to advance social justice.

[1] For an excellent primer on fat studies, see The Fat Studies Reader edited by Esther Rothblum and Sondra Solovay. One can also consult the “Further Resources” list on my website.

[2] Last year, the mayor of Rio de Janeiro made a campaign promise that if re-elected he would make a generic version of Ozempic widely available at low cost, boasting that under his leadership: “Rio will be a city where there will be no more fat people, everyone will be taking Ozempic at family clinics.” “A mayor promises Ozempic for all and says there 'will be no more fat people' in his city”

[3] “The Report Card on BMI Report Cards”

[4] “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity”

[5] “Georgia Anti-Obesity Ads Say ‘Stop Sugarcoating’ Childhood Obesity”

[6] For details of the relevant studies and a more in-depth discussion of the empirical findings surveyed in this section, see Chapter 3 of Why It’s OK to Be Fat.

[7] A question that naturally arises today is that if traditional dieting does not work, should we turn to GLP-1 weight-loss drugs such as Ozempic as the answer to our nation’s “weight problem”? On this matter, see Chapters 3 and 8 of Why It’s OK to Be Fat.

[8] “Prevalence of eating disorders over the 2000–2018 period: a systematic literature review”

[9] “The social media diet: A scoping review to investigate the association between social media, body image and eating disorders amongst young people”

[10] Ibid.

[11] “Body Image and Eating Disorders”

[12] “Attempts to Lose Weight Among Adolescents Aged 16–19 in the United States, 2013–2016”

[13] “Onset of adolescent eating disorders: population based cohort study over 3 years”

[14] “Atypical Anorexia”

[15] There are two exceptions: “bone density loss and low blood sugar, which are worse in those who are emaciated.” “You Don’t Look Anorexic”

[16] The remainder of this section surveys evidence discussed in Chapter 2 of Why It’s OK to Be Fat.

[17] “Pervasiveness, Impact and Implications of Weight Stigma”

[18] Ibid.

[19] “The Negative and Bidirectional Effects of Weight Stigma on Health”